Compliance System Data Support Specialist - 25-137

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Essential Responsibilities

Reporting

• Produce and customize regulatory reporting requirements of health plans to meet their report needs and ensures accurate data and timely delivery.
• Create standardized and proprietary reports according to contractual, regulatory, and/or technical requirement specifications
• Develop and/or Monitor data validation tools and processes
• Perform data validation procedures to ensure accuracy in reporting
• Generate and validate scheduled reports before delivery to health plans and/or regulatory agencies
• Maintain schedule of required reports to ensure timely delivery
• Identify departments, businesses, technical owners impacted by report requests
• Distribute report-related information and recommend tasks to identified report team members.
• Coordinate and chair report team meetings for new and ongoing requirements with applicable teams
• Establish report delivery method, coordinate STFP, TLS, or Secure email.

Compliance/Audit Support

• Review and validate new and or enhanced Health Plan and regulatory agency reporting requirements.
• Coordinate communication with Health Plan to clarify reporting requirements.
• Review new/amended delegation agreements with Contracting

System Requirements and Testing

• Participate in system implementations, upgrade, and enhancement projects
• Coordinate, assign, and complete report testing plans in the development, implementation, and upgrade process.
• Quality Assurance is performed at a high level to assess immediate reporting impacts and report the outcomes
• Assess the need of developing new operational processes for new products and, develop or revise existing processes, work with relevant departments to ensure that implementation and testing of systems are complete and meet regulatory reporting requirements.

Project Coordination, Process Improvement & Compliance Monitoring

• Collaborates and communicates with various customers, vendors, and internal departments/teams to improve the quality of data and information workflows
• Act as the liaison between internal business units, and health plan partners, to assist with the coordinating interdepartmental workgroup meetings.
• Collaborate with Business units in developing monitoring reporting tools that help guide business decisions.
• Research and reconcile data discrepancies occurring among various information systems and reports
• Participate in and improve the organization's quality assurance procedures.
• Identify areas of workflow that can be streamlined, such as internal automation of reports.
• Facilitate and correct technical issues by monitoring reports to make suggestions for process improvements based on identified/observed trends in data
• Other duties as assigned

Non-Essential Responsibilities

• Other related duties as assigned
• Adhoc team meetings
• Collaboration, check-in and follow up among team members
• Other duties as assigned

Skills and Experience Required

• Experience with system/application implementations and testing preferred.
• Professional communication skills.
• Strong oral, written, and reading comprehension and organizational skills necessary.
• Ability to work independently and as part of a team.
• Ability to conduct thorough research related to regulatory requirements as it applies to systems and operations.
• Ability to interface with all levels of management.
• Demonstrated project coordination skills. Ability to prioritize multiple projects and tasks. Must be able to contribute to cross-functional workgroups both as a leader and participant.
• Expert knowledge with routine application software Authorizations, Claims, and Customer Relationship Management (CRM). I (Epic - Tapestry, Clarity, Webi, and Tableau report writing skills and extraction preferred).
• Expert knowledge with Microsoft Suite (Outlook, Word, Excel, PowerPoint, and Visio (Access a plus). Project Management Software and Tools a Plus.
• Health care experience required (preferably in the managed care industry).
• Demonstrated ability to exercise -sound judgment, adapt to quickly changing priorities and needs, prioritize multiple tasks, problem solve under pressure of deadlines and resource constraints.
• Strong sense of urgency with project completions, ability to collaborate with others.

Required Education

• Bachelor's Degree preferred, or any combination of academic education, professional training, or work experience, which demonstrates the ability to perform position's duties.

Additional Information

This position may require travel to other PriMed offices, physician offices, or work-related locations as needed.

Salary: $85,000 - $97,000 Annual

Hill Physicians is an Equal Opportunity Employer