Compliance Analyst III – Delegation Oversight

About the role

The Delegation Oversight Compliance Analyst supports the implementation and ongoing execution of the health plan’s delegation oversight program, helping ensure compliance with DMHC, Knox Keene, CMS, and NCQA requirements. This role contributes to the oversight of delegated entities (e.g., medical groups, subcontracted plans, vendors) across key functions such as utilization management, claims processing, grievances and appeals, credentialing, and care management.

Responsibilities

• Prepare and organize audit documentation
• Support audit execution and follow-up activities
• Maintain oversight trackers and dashboards
• Analyze performance and compliance data
• Identify potential risks or gaps
• Partner with internal stakeholders to support timely issue resolution and continuous quality improvement
• Support governance and reporting processes, including preparation of materials for committee meetings, tracking regulatory reporting requirements, and maintaining documentation to demonstrate audit readiness
• Serve as a point of coordination with delegated entities to collect required information, support oversight activities, and ensure timely submission of required deliverables

Requirements

• Equivalent experience will be accepted in lieu of the required degree or diploma.
• Bachelor's in Business Administration or related field
• 5 years recent relevant experience

Skills and Knowledge

• In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting and documenting investigations, addressing violations, tracking corrective actions, and training.
• Knowledge of healthcare clinical operations, hospital revenue cycle systems, healthcare billing and coding requirements, or other healthcare compliance requirements/issues.
• Knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources.
• Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal).
• Attention to detail with time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines.
• Understanding of business acumen and analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.
• Excellent written/verbal communication, interpersonal, and presentation skills with the ability to understand legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences.
• Proficient computer skills, including competency in Microsoft Office Suite (Word, Excel, and PowerPoint), Visio, Project, Crystal Reporting, and other software.
• Ability to manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.
• Identify potential concerns and compliance issues, and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem.
• Advise management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations.
• Work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established timeframes and government regulations.
• Make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.
• Foster an open and collaborative environment that invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.
• Maintain strict confidentiality of sensitive material (compliance and risk management data) and ensure the privacy of each patient’s protected health information (PHI).
• Work effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.
• Build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.

Pay

$104,332.80 to $156,499.20 / annual salary

Benefits

Yes

Unions

No

Status

Exempt

Weekly Hours

40

Employee Status

Regular

Pay Range

Based on the geographic location where the position is filled.

Total Compensation

Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs.

Base Pay

Base pay is only one component of Sutter Health’s comprehensive total rewards program.

Eligible Positions

Includes a comprehensive benefits package.