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Providence PHO Audit and Compliance Analyst (Remote: SW WA / OR) in Vancouver, Washington


Providence is calling a PHO Audit & 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

  • Work as a liaison for external delegated entities to provide operational support in addition to auditing and monitoring delegated functions

  • Work 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

  • Work closely with the Clinical Analytics and Information Systems teams to develop, review and validate internal and external audit reports

  • Assist teams with the review and interpretation of regulatory guidance and requirements as well as policy and procedure development

  • Work 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)

We welcome 100% remote work for residents of Southwest Washington and Oregon.

Primary Responsibilities:

  • Works 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 routinemonitoring and auditing of HCS programs

  • Partners 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

  • Coordinates 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

  • Assists 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

  • Assimilates 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- a combination of equivalent education and experience

  • 3 years demonstrated successful experience working with administrative, policy and/or operational aspects of managed care

  • 3 years experience in project management, data analysis and policy and procedure development

  • 1 year experience in technical or operational policy & procedure writing as it relates to regulatory requirements and accreditation standards

  • Proven track record of assessing program compliance and establishing auditing and monitoring protocols

  • Experience with managed care regulatory compliance matters in one or more of the following lines of business (Medicare, Medicaid, Commercial)

Preferred qualifications for this position include:

  • Experience with CMS and State Medicaid regulations and programs as they relate to Medical Management

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Requsition ID: 140555
Company: Providence Jobs
Job Category: Compliance
Job Function: Legal/Compliance/Risk
Job Schedule: Full time
Job Shift: Day
Career Track: Business Professional
Address: OR Beaverton 3601 SW Murray Blvd

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.