Job Description

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)

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

Licenses, Certifications

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.

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