Compliance Analyst, Senior (Operations)

The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change. 

We are hiring a Compliance Analyst, Senior (Operations) to join our team!

Must reside in California - remote position. 

What You Will Be Doing:

Under general supervision, the Compliance Analyst, Senior (Operations) is responsible for providing decision support and insightful guidance and completing complex regulatory activities. Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment. 

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Leads complex compliance programs and strategic initiatives, oversees planning, execution, and continuous improvement to enhance regulatory adherence and operational efficiency.
• Oversees and conducts comprehensive risk assessments of HPSJ’s business practices to identify areas of exposure; develops and recommends mitigation strategies and action plans to address risks effectively.
• Conducts advanced research and analysis of contractual, regulatory, and legal requirements for HPSJ and its delegated vendors; provides expert interpretation to ensure compliance.
• Drives the implementation of key Compliance and enterprise-wide initiatives by coordinating efforts across departments, monitoring progress, resolving barriers, and escalating issues as needed.
• Provides expert guidance and training to internal and external stakeholders to promote understanding of and adherence to regulatory, contractual, and accrediting requirements, as well as organizational policies and procedures.
• Assesses the financial impact of compliance issues and provides actionable reports to inform leadership decisions.
• Develops, refines, and presents routine and ad-hoc Compliance Reports, offering actionable insights through clear written interpretation of analytical findings for both internal and external stakeholders.
• Ensures accurate data management by entering and maintaining information, documents, and records in compliance software and other systems, adhering to organizational and regulatory standards. 
• Creates, updates, and manages policies and procedures to ensure compliance with federal/state laws, regulations and program standards.
• Assists in the development, implementation and maintenance of best practice policies, procedures, standards and other tools; facilitates use and understanding among stakeholders.
• Provides comprehensive support and serve as a backup for team members across various functions, ensuring seamless continuity of compliance program management and oversight during absences or high-demand periods.

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required:

• Expert-level knowledge of federal and state regulations and standards, including the False Claims Act, Medi-Cal, Medicare and DMHC/DHCS/CMS, with the ability to interpret and apply evolving regulatory requirements to compliance operations in healthcare.
• Strong writing skills with a strong attention to detail.
• Advanced knowledge of managed care health plan functions and interdepartmental interactions, with the ability to assess and mitigate compliance risks across various business areas.
• Knowledge of contracting regulations and best practices, including risk assessment, and vendor compliance monitoring.
• Highly developed analytical skills, including the ability to conduct complex data analysis, synthesize information from multiple sources, identify trends, and develop actionable compliance recommendations.
• Exceptional attention to detail, ensuring all compliance activities, audits, and reporting meet accuracy and completeness standards.
• Ability to manage high work volumes efficiently, prioritizing tasks based on risk level and regulatory deadlines.
• Proactive learning approach, demonstrating a commitment to continuous development and leveraging insights from industry trends, regulatory updates, and compliance challenges.
• Resilient problem-solver, with the ability to navigate and address compliance challenges, regulatory changes, and organizational setbacks with adaptability and strategic thinking.
• Process improvement expertise, identifying inefficiencies in compliance workflows and leading initiatives to enhance operational effectiveness.
• Advanced data analysis skills, with the ability to interpret and visualize complex datasets, develop compliance dashboards, and present insights to leadership.
• Strong problem-solving capabilities, including the ability to analyze multifaceted compliance issues, evaluate potential impacts, and develop strategic solutions.
• Exceptional research skills, with the ability to assess and synthesize complex regulatory information, evaluate compliance risks, and develop clear guidance for stakeholders.
• Strong knowledge of and ability to apply the principles and best practices of project management, including but not limited to: project lifecycle, scope definition and management, planning and scheduling, monitoring, communication cycles, project team and risk management
• Superior organizational and project management skills, including the ability to lead multiple compliance initiatives simultaneously, manage stakeholder expectations, and delegate tasks effectively.
• Strong stakeholder engagement and interpersonal skills, with the ability to collaborate with internal and external
• partners, regulatory agencies, and cross-functional teams.
• Advanced oral and written communication skills, with the ability to draft, refine, and present policies, reports, and compliance training materials clearly and persuasively to diverse audiences.
• Strong presentation skills, including the ability to engage, educate, and influence senior leadership, external regulators, and large groups on compliance matters.
• Advanced time management and prioritization skills, ensuring the timely completion of high-impact compliance initiatives while maintaining flexibility to address urgent issues.
• Strong vendor management skills, with ability to objectively evaluate, assess, select, and manage vendors.
• Strong leadership and influence skills, with the ability to mentor junior compliance staff, drive organizational compliance culture, and lead cross-functional initiatives without formal authority.
• Commitment to and ability to drive the adoption of HPSJ’s strategic vision, mission, and compliance culture, ensuring alignment with regulatory expectations and corporate goals.
• Advanced mathematical and statistical analysis skills, including the ability to calculate and interpret financial and risk-related compliance data.
• High proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Visio, and Project), with the ability to create professional reports, presentations, and compliance process documentation.
• Strong ability to handle confidential information with discretion and adherence to legal and ethical compliance standards.

What You Have:

Education and Experience

Required

• Bachelor’s degree in business administration, Healthcare Administration, Public Health, Law, Finance or a related field; and
• At least three or more years of compliance, regulatory, audit, risk management in healthcare, insurance, finance or a highly regulated environment; or
• At least three years or more of experience with contract management, regulatory reporting, risk assessments and audit; or
• Project and/or program management related skills; or
• Equivalent combination of education and experience

 Preferred

• Master’s Degree (MBA, MHA, MPH, or JD)[KV1] 

Experience in project management in healthcare and/or managed care and/or Medi-Cal/Medicaid and/or Medicare

Licenses, Certifications

Required

• None

Preferred:

• Certified in Health Care Compliance(CHC)
• Project Management Professional (PMP)

What You Will Get:

 HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects. 

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics. 

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.