Job Description:

Job Posting Title

Compliance Analyst

Agency

807 HEALTH CARE AUTHORITY

Supervisory Organization

Medical Services

Job Posting End Date (Continuous if Blank)

February 28, 2023

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time

Full time

Job Type

Regular

Compensation

51,400.00 / annual

Job Description

Basic Purpose

The incumbent will be under the general direction of the QA/SoonerCare Select Compliance Manager. The incumbent will assist in the review and reporting of referrals and claims data to analyze provider compliance with contractual standards, as well as the coordination, resolution and compliance of SoonerCare member and provider issues received through the Oklahoma Health Care Authority according to OHCA established rules.  The incumbent will assist in the general planning and development of special projects related to the operational, implementation, and development activities for SoonerCare.

Typical Functions

• Proficient use of databases such as Access; Microsoft office applications such as Outlook, Word, Excel, PowerPoint, OneNote, Teams, Visio, Adobe Pro, and SharePoint.


• Utilize the MMIS system to query claims data and prepare claims data for Quality Assurance team analysis. Transfer data into databases.

• Coordinate Quality Assurance (QA) complaint and issue processes from creation to closing. Requests medical records and track receipt. Process certified mail and track receipt.

• Assist with research, investigation and resolution of complaints and issues. Enter QA database documentation.


• Compile data and information. Generate and reconcile QA reports and dashboards. Analyze reports and assist with dissemination of data.


• Assist with Quality Improvement Organization (QIO) compliance monitoring. Audit QIO process and reconcile related reports.


• Coordinate Patient Centered Medical Home (PCMH) audit processes, including selection, scheduling, communications, provider notifications and database maintenance.


• Contribute to QA team initiatives, and support quality assurance activities and Agency strategic work plan development.


• Obtain and maintain documentation regarding provider license monitoring and board notifications; perform licensure board queries; assist with provider research; and prepare related QA data and reports.


• Collaborate and coordinate with other units and divisions as needed.


• As directed, attend meetings inside and outside the agency as a SoonerCare representative. Responsibilities may include meeting coordination; creation of pre-meeting documents (agenda, files, etc.); recording meeting notes; updating related database (tracking activities, logging legal notices, interventions, etc.); and creating ad hoc reports. 


• Disseminate information to individuals, business groups, community representatives and other program stakeholders. 


• Maintain Quality Assurance team process mapping.


• Assist with identification of process improvements and strategies to meet unit goals.


• May assist with analyses of encounter data including validation of submitted encounter claims and identification of providers who may not be submitting encounters.


• Other duties as assigned.

Education and Experience

• Bachelor’s degree OR


• 4 years of related experience in quality assurance, data analysis, or complaint resolution and experience in using a database computer program OR


• An equivalent combination of education and experience, (substituting 30 semester hours for each year of experience) totaling 4 years 

Preference may be given to candidates with:

• MMIS or MIS operations experience or education


• SoonerCare experience


• Quality assurance experience


• Experience with database development and maintenance


• Advanced education related to job skills or activities

Special Requirements

Physical Demands:

• Must be able to remain sitting for prolonged periods at a desk and working on a computer.


• Must be able to move or lift up to 15 pounds at various times.

Work Environment:

• The office work environment includes regular exposure to general office equipment such as computer equipment, phones, and copy machines. 

Accommodation Statement:

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335. 

Notice to applicants:

Please add personnel@okhca.org to the address book or “safe-senders” list in your email.  All correspondence will come from this address.  Be sure to check your junk folder.  If you have questions about the status of your application, you can contact the HR team at 405-522-7093.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Current State of Oklahoma employees: must apply for open positions through their Workday account.  To apply internally, Go to Careers App located on Workday home screen> Click on “Find Jobs-Internal State of Oklahoma”.

**A complete job application includes: Resume/CV attached with a complete work history and education.**

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current State of Oklahoma employees must apply for open positions through their Workday account. Go to Careers app on WD home screen>Click on 'Find Jobs-Internal State of Oklahoma'.

Apply Now