Compliance Analyst CFHP

POSITION SUMMARY/RESPONSIBILITIES

Works to utilize the department’s resources to support internal compliance auditing, monitoring activities and oversight related to managed care compliance. Assists in the execution of internal audits, including audit planning, documentation, and follow-up activities. Analyzes data across systems to identify, investigate, and track compliance risks, recommending corrective actions as needed. Supports control testing and validation to ensure adherence to regulatory requirements, including the Centers for Medicare & Medicaid Services (CMS), Texas Health and Human Services Commission (HHSC), and Texas Department of Insurance (TDI) guidelines. Ensures organizational compliance with National Committee for Quality Assurance (NCQA), as applicable. Assists in the development, analysis, and presentation of reports to support compliance and audit functions, including Audit Committee and Board-level reporting. Performs duties and assignments promptly and efficiently while upholding the department’s reputation for creditability and objectivity. Maintains effective working relationships with health plan leadership, staff, and external partners, and handles all interactions with professionalism, efficiency, and integrity while safeguarding the confidentiality of sensitive information.

EDUCATION/EXPERIENCE

A bachelor’s degree in accounting, finance, healthcare administration, business administration, or a related field is required, or at least two (2) years of experience in risk management, internal auditing, or compliance. Project, risk management, and change control experience is preferred. #J-18808-Ljbffr Community First Health Plans