Providence Health & Services Health Care Services Audit and Compliance Analyst in Beaverton, Oregon
Providence St. Joseph Health is calling a Health Care Services Audit and Compliance Analyst based out of our location in Beaverton, OR. This position will be remote.
We are seeking a Health Care Services Audit and Compliance Analyst who will handle various elements of program compliance, policy development auditing, monitoring and report development within the Health Care Services teams including Care Management and Utilization Management.
This position works as a liaison for external delegated entities to provide operational support in addition to auditing and monitoring delegated functions. This position works with the Regulatory Compliance & Government Affairs department (RCGA) to evaluate state and federal regulations as they apply to Health Care Services and the various lines of business. The Analyst position will also work closely with the Clinical Analytics and Information Systems teams to develop, review and validate internal and external audit reports. This position will also assist teams with the review and interpretation of regulatory guidance and requirements as well as policy and procedure development. Other key elements of this position are working closely with business partners and delegates, providing monitoring and oversight of their activities as they relate to Providence Health Plans to ensure they are compliant with all regulatory requirements, accreditation standards for the National Committee for Quality Assurance (NCQA) and meeting all client Service Level Agreements (SLA's).
1.Complex work environment involving multiple lines of business with different regulatory and accreditation standard requirements across different teams.
2.Requires strong ability to coordinate activities across multiple departments within the Health Plan and with external vendor's and delegates.
3.Maintaining up-to-date knowledge of compliance requirements and key operational systems at PHP.
4.Effectively communicating with diverse employees throughout the health plan and with our delegate partners.
5.Manage multiple tasks, shifting priorities and externally imposed deadlines as well as business need deadlines.
Patient Population Served: Not Applicable
In this position you will have the following responsibilities:
Work closely with RCGA and Quality Management to interpret and evaluate new and existing state and federal regulations and accreditation standards to assess potential changes and impacts on HCS programs, operations and polices.
Conduct the oversight of departmental monitoring and auditing schedule to ensure compliance with requirements for routine monitoring and auditing of HCS programs.
Partner with IS and Clinical Analytics on the development of reporting for accreditation, external regulatory review, audit activities, disease management, case management, concurrent review, prior authorization, and other UM and CM functions.
Coordinate delegate and vendor oversight, executes auditing and monitoring activities of these entities to assure programand service level compliance with all regulatory requirements and client agreements.
Assist in the development of monthly audit dashboards, audit risk assessments and audit metrics.
Independently audits and develops work plans and/or corrective action plans for the HCS team and its delegates
Assimilate internal and external required reports for all lines of business and prepares them for internal stakeholders to meet required reporting timeframes.
Responsible for supporting the HCS Compliance Program. Works with department operations in preparation for regulatory and accreditation audits.
Required qualifications for this position include:
Bachelor's Degree in Business Administration, Healthcare Administration, or other related field or consideration may be given for candidates who have comparable experience in lieu of a bachelor's degree.
3 years demonstrated successful experience working with administrative, policy and/or operational aspects of managed care.
Proven track record of assessing program compliance and establishing auditing and monitoring protocols.
3 years experience in project management, data analysis and policy and procedure development.
Experience with managed care regulatory compliance matters in one or more of the following lines of business (Medicare, Medicaid, Commercial).
1 year experience in technical or operational policy & procedure writing as it relates to regulatory requirements and accreditation standards.
Preferred qualifications for this position include:
- Experience with CMS and State Medicaid regulations and programs as they relate to Medical Management.
About Providence in Oregon.
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple, "Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Compliance
Other Location(s): Oregon
Req ID: 315752