Job Description| JOB TITLE | Sr. Compliance Analyst | REPORTS TO | Compliance Officer |
| STATUS | FT, Exempt | WAGE RANGE | 18 (2024) |
| DEPARTMENT | Compliance | WORK LOCATION | Remote / Hybrid (travel to community for business need may be required) |
| POSITION PURPOSE |
The Senior Compliance Analyst supports Umpqua Health Alliance’s compliance with the Oregon Health Authority (OHA) Coordinated Care Organization (CCO) contract by overseeing key audit, monitoring, and regulatory functions. This position plays a central role in coordinating external audits, maintaining compliance with applicable state and federal Medicaid regulations, and implementing corrective actions resulting from regulatory findings. The role requires a CHC certification and at least five years of healthcare compliance or audit experience, preferably in a Medicaid managed care environment.
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| ESSENTIAL JOB RESPONSIBILITIES |
- Manage and coordinate all activities related to the External Quality Review (EQR) conducted by the state’s designated External Quality Review Organization (EQRO), including document production, stakeholder coordination, timeline tracking and audit facilitation.
- Conduct compliance audits of provider groups identified by UHA’s Special Investigations Unit (SIU) for potential fraud, waste, and abuse (FWA), ensuring adherence to applicable Oregon Administrative Rules (OARs), federal regulations, and contractual requirements.
- Maintain working knowledge of the Oregon CCO contract, applicable sections of the Code of Federal Regulations (CFR), and Oregon Administrative Rules (OARs) governing CCO compliance.
- Track and interpret compliance requirements under 42 CFR §438 Subpart E, ensuring organizational readiness for external audit and performance review activities.
- Coordinate internal assessments to validate compliance with CCO contractual obligations, performance measures, and reporting deliverables.
- Lead or support corrective action planning and remediation activities in response to findings from OHA, EQRO, or other oversight bodies.
- Facilitate internal control documentation, risk assessments, and testing to ensure ongoing operational compliance with state and federal Medicaid requirements.
- Respond to regulatory inquiries, audit requests, and OHA monitoring activities, including gathering supporting documentation and ensuring consistency in external responses.
- Collaborate with operational teams to develop and document processes that fulfill contract-required activities, including care coordination, grievance systems, access standards, and quality improvement.
- Maintain compliance tracking tools and develop reports that highlight key risk indicators, audit status, and compliance trends.
- Serve as the compliance liaison to all subcontracted entities, supporting contract compliance, data requests, monitoring activities, and issue resolution
- Participate in cross-functional committees and workgroups to ensure coordination of compliance-related deliverables and communication of regulatory changes.
- Develop and deliver training on contractual and regulatory compliance topics, including annual updates related to EQR protocols and audit expectations.
- Support the development and submission of contract deliverables related to EQR, performance improvement projects (PIPs), compliance monitoring, and grievance system validation.
- Ensure compliance with all applicable state and federal laws.
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| CHALLENGES |
- Working with a variety of personalities, maintaining a consistent and fair communication style.
- Thriving in a dynamic and fast-paced environment while meeting the evolving needs of an innovative organization.
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| QUALIFICATIONS |
Minimum Qualifications- CHC (Certified in Healthcare Compliance) required.
- At least five (5) years of healthcare compliance or auditing experience, with significant experience in Medicaid managed care.
- Knowledge of OHA’s CCO contractual requirements, 42 CFR §438, and Oregon’s Medicaid regulatory framework.
- Experience coordinating or supporting EQR, CMS audits, or state performance reviews.
- Demonstrated ability to interpret and apply complex regulatory and contractual language to operational processes.
- Strong writing, organization, and project management skills; ability to manage multiple deadlines with minimal oversight.
- No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid)
- Proficient computer skills, including MS Office suite
Preferred Qualifications- Bachelor’s degree in Public Health, Healthcare Administration, Business, or a related field.
- Experience working directly with or for an Oregon CCO, EQRO, or state Medicaid agency.
- Familiarity with Oregon Administrative Rules, CCO audit protocols, and contract deliverable tracking systems.
- Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis
- Experience working on a diverse team
- Experience working with different communication styles
- Bi-lingual translation or translation capabilities a plus
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| PHYSICAL DEMANDS/ WORK CONDITIONS |
A typical office environment requires standing, sitting, walking, bending, and lifting up to 25 plus pounds.
Ability to travel and drive to in-person meetings, provider site-visits or legal proceedings as required. |
| EQUAL EMPLOYMENT OPPORTUNITY |
UH is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. UH makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, read through our EEO Policy. |
| JOB DESCRIPTION ACKNOWLEDGEMENT |
| I have reviewed the attached job description as outlined above and understand that I am responsible for all duties as outlined and other tasks as may be assigned. I understand that if I need accommodation to perform the essential functions of my job that I must contact my supervisor or Human Resources as soon as possible to begin an interactive process. |
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| Note: This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. |
About Umpqua Health
At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.