Compliance Business Analyst

Payer Compass is looking to fill a Compliance Business Analyst position.

Department: Compliance Location: Plano, TX or Remote

Basic Functions:

The Regulatory Business Analyst will work with the Payer Compass compliance team to further the company’s goals to develop and implement new software solutions within the Visium platform.

One of the most important roles of the business analyst is to research new opportunities, vet them out with our partners and define business requirements that also include the approach for implementation.

Job Responsibilities:

  • Define requirements related to compliance, legislation, and business operations for the purpose of developing solutions for our internal and external partners in the following areas: claim pricing, finance, customer service, provider data, member data, and client needs
  • Work closely with the client, project managers, and/or internal teams to ensure that requirements are resolved and/or handled appropriately to conclusion
  • Research and document requirements and responses
  • Perform in-depth and complex research, fact-gathering, analysis, and interpretation of applicable laws and statutes pertaining to healthcare regulations and all other issues pertaining to business operations
  • Conducts interviews and information gathering analyzes data and documents findings
  • Updates internal documentation and processes as needed
  • Manage competing priorities and deliver quality information and analysis while adhering to deadlines
  • Create and standardize business requirements documentation processes and workflows
  • Manage BRD deadlines with necessary tools for completion tracking and clearly identifying open items that need inputs from stakeholders
  • Identify issues upfront and communicate clearly to team members and leadership.
  • Participates in the management of the sequencing of releases to meet business needs for enhancements, automation, and implementations
  • Ensures continuing operational support by documenting changes and enhancements
  • Provides training to staff on a need basis and act as a mentor for new team members
  • Perform data analysis tasks (i.e. fee schedules, provider files, base rates)
  • Assisting with implementations, quality assurance activities, compliance audits, troubleshooting, and defect correction
  • Miscellaneous responsibilities as assigned

Education and Work Experience:

  • Bachelor’s degree or above in healthcare administration, business administration, a related field, or equivalent experience
  • Certified Business Analyst is strongly preferred, or equivalent demonstrated business analysis experience
  • Extensive experience with Agile development, System Design Life Cycle (SDLC), or other industry-standard methodology
  • Experience with writing queries a plus

Knowledge, Skills and Key Competencies:

  • Superior root-cause analysis skills, including corrective action planning and the ability to provide documentation to support analysis
  • Extensive knowledge in health insurance third party administrator concepts related to compliance and business operations reporting needs in one or more of these programs: referenced base pricing, Medicaid, Medicare Advantage, other government programs, exchange, and commercial plans
  • Working knowledge of documenting data element requirements, rules pertaining to these data elements, and applicable regulations outlined based on state and CMS guidelines
  • Strong communication and facilitation skills
  • Strong time management and organizational skills
  • Excellent interpersonal, oral, and written communication skills
  • Strong attention to detail and organization
  • Able to work independently and within a collaborative team environment with little guidance/supervision.
  • 3+ years of experience leading projects and cross-functional teams
  • Superior verbal and written communication skills
  • Ability to understand in-house developed systems and identify risks with, or gaps in, those systems
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