• Job Description

  Req#: 364955

  Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

  Providence Health Plan is calling an 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
  • 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 who reside in one of the following States / Region of Residency:

  • Oregon
  • Washington
  • California

  Required qualifications for this position include:

  • Bachelor's Degree in Business Administration, Healthcare Administration, or another related field of study -OR- a combination of equivalent education and experience
  • 3+ years' experience working with administrative, policy and / or operational aspects of managed care
  • 3+ years' experience in project management
  • 3+ years' experience in data analysis
  • 3+ years' experience in procedure development
  • 1+ years' experience in technical or operational policy and procedure writing as it relates to regulatory requirements and accreditation standards
  • Experience with managed care regulatory compliance matters in one or more of the following lines of business: Medicare, Medicaid, Commercial
  • Experience assessing program compliance and establishing auditing and monitoring protocols

  Preferred qualifications for this position include:

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

  Why Join Providence?

  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 the company

  Providence Health & Services is a not-for-profit, Catholic health care system operating multiple hospitals across seven states, with headquarters in Renton, Washington. The Providence affiliate family includes: Covenant Health, Facey Medical Group, Kadlec, Pacific Medical Centers and Swedish Health Services.

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