Compliance Analyst

Payer Compass is looking to fill a Compliance Analyst position in Plano, TX or Remote

Department: Compliance Location: Plano, TX or Remote

Basic Functions:

The Compliance Analyst will work with the Payer Compass compliance team to further the company’s goals by researching, analyzing, documenting, and communicating rules, regulations, and procedures pertaining to public and private healthcare payment systems such as Medicare, Medicaid, TRICARE, Workers Compensation, and commercial payment systems. This position requires an in-depth knowledge of healthcare reimbursement processes and procedures including institutional, as well as, professional payment systems. Further, this position is an internal resource to staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.

  • Researching and deciphering legal and regulatory sources regarding payment rules for public payment systems such as Medicare, Medicaid (in multiple states), TRICARE, Veteran’s Administration, and Workers Comp (also in multiple states) as well as deciphering contractual language regarding commercial payment arrangements
  • Drafting concise documentation for payment procedures—including payment calculation logic—and interacting with the development team to refine that documentation into user stories and project plans
  • Performing data analysis tasks (i.e. fee schedules, provider files, base rates) using in-house or off-the-shelf software (such as Microsoft Excel)
  • Interacting with regulators and clients to determine and document requirements
  • Assisting with quality assurance activities, compliance audits, troubleshooting, and defect correction
  • Educating internal and client staff regarding payment systems and procedures
  • Work with supporting staff to oversee one or more payment systems

Education and Work Experience:

  • Bachelor’s degree or above in healthcare administration, business administration, or a related field
  • Minimum of two years of experience in Medicare Part A and/or Part B billing and reimbursement
  • Experience with Medicaid billing and reimbursement a plus

Knowledge, Skills and Key Competencies:

  • Strong close-reading and analytical skills—the ability to correctly decipher dense regulatory or procedural language
  • Ability to define issues, collect data, establish facts, and draw valid conclusions
  • Strong research skills
  • Experience with writing queries a plus
  • A good understanding of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, preferred-provider organizations, narrow networks, and other healthcare-related organizational constructs
  • Ability to understand in-house developed systems and identify risks with, or gaps in, those systems
  • Ability to prioritize multiple tasks and meet deadlines with minimal supervision
  • Strong written and verbal communications skills

Protects and maintains patient and institutional information in a confidential manner and in a secured environment. Ensures data access limitations through the use of password protection, read-only access, and other measures that protect the data from unauthorized or accidental access.

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