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Regulatory Reporting Analyst

4 months ago

Fairfield, United States Partnership HealthPlan of California Full time

Overview:
To develop and implement long-term quantitative analysis strategies to meet NCQA and DHCS

standards for reporting. To perform, and assist in the performance of, duties that ensure the

accuracy, completeness and truthfulness of enterprise wide regulatory reporting including all data,

information and documentation submitted to PHC’s governing agencies. Works collaboratively

requirements or templates and assist in troubleshooting regulatory reporting issues. To develop

and implement strategies to meet NCQA standards for the oversight of delegate reporting.

Supports the plan-wide Privacy and Fraud, Waste and Abuse (FWA) program by preparing trend

analysis, forecasting reports and managing data collection in EthicsPoint.

**Responsibilities**:

- Responsible for independently validating the accuracy of regulatory reports submitted to
the Regulatory Affairs and Compliance (RAC) unit by department SMEs or delegates to
ensure reporting is in conformance with the regulatory agencies reporting template and
contains the required attributes specified in reporting instructions prior to filing with PHC’s
governing agencies.
- Develops and maintains working knowledge of PHC’s governing agencies reporting
requirements and NCQA standards for the oversight of delegation reporting to work with
key department SMEs to support compliance with all reporting requirements and NCQA
standards and assist in troubleshooting regulatory reporting issues.
- Project/program involvement will include working with department SMEs to implement new
reporting requirements for new programs and benefits including DHCS Drug Medi-Cal and
CCS Whole Child Model.
- Communicate regulatory reporting changes to existing regulatory reporting templates or
other reporting requirements to all department SMEs and the Delegation Oversight unit and
work with affected departments to implement changes.
- Works closely with department SMEs and Delegation Oversight unit to resolve any
regulatory report quality issues.
- Serves as primary contact for internal and external regulatory reporting related inquiries.
- Maintain PHC’s Regulatory Reporting Calendar, Master List Tracking Sheet and Data
Certification
- Serves as an active contributor in data quality or analytic workgroups and assist in
developing data governance and data quality issue resolution, streamline reporting to
reduce unnecessary duplication; ensures consistent and accurate use of regulatory data
reporting.
- Under the direction of the Regulatory Affairs Manager, works on analyzing and documenting
current processes to determine process needs that will improve the performance and/or
increase efficiency within the unit.
- Assist in developing or updating RAC’s processes including policies and procedures,
desktop procedures, workflows, best practices and training materials.
- Develop quantitative and trending reports for Privacy and FWA reported incidents via
EthicsPoint advanced analytic tools.
- Enhance current tracking and trending mechanisms to consolidate into EthicsPoint.
- Prepare and distribute standard daily, weekly, monthly and quarterly reports and present
Privacy and FWA statistic reports to the PTAS and FWA workgroups or Compliance
Committee as a backup for the Regulatory Affairs Manager.
- Provide back up and support to Regulatory Affairs Specialist as required in Privacy and
FWA investigations, including creating randomized data sampling or other analysis
required.
- Research complex regulatory related inquires, provide accurate and timely response
utilizing all applicable State and Federal regulations.
- Supports compliance training program.
- Supports internal and external audits
- Participates in special projects and assignments as needed
- Other duties as assigned.

Qualifications:
**Education and Experience**

Bachelor’s degree in relevant field; two - three (2-3) years of experience
- in the health care field, managed care experience preferred; must have
- knowledge of regulatory related reporting requirements and Medi-Cal
- regulations; experience with data analytics and forecasting trends
- preferred; or equivalent combination of education and experience.**Special Skills, Licenses and** **Certifications**
- PC usage, Microsoft Word, PowerPoint, Excel, Visio, SharePoint, typing
- speed 45 wpm. Valid California driver’s license and proof of current
- automobile insurance compliant with PHC policy are required to operate
- a vehicle and travel for company business.**Performance Based Competencies**

Excellent oral and written communications skills. Excellent organization
- skills with ability to prioritize assignments, and maintain effective filing
- systems. Ability to work under mínimal supervision and exercise
- excellent independent judgement. Diplomacy and tact in handling
- sensitive information regarding personnel affairs as required. Ability to
- interact with executives and vendors effectively, handling all
- assignments with efficiency. Must b