The Contract Compliance Analyst is accountable to ensure Kaiser Permanente Northwest’s (KPNW) provider, facility and health care benefit managers' (HCBM) contract filings meet regulatory compliance with the Washington State Office of the Insurance Commissioner (WA OIC). The Contract Compliance Analyst manages KPNW’s SERFF filing processes from analytical review, preparation and submission, to tracking, assessing and resolving active suspensions, to compliant disposition. The position will lead and manage contract compliance projects and support regulatory audit responses and tracking.
The Contract Compliance Analyst collaborates with leadership to ensure successful implementation of regulatory changes and policies impacting our Provider Contracting team. The professional in this position has the ability to maintain confidentiality, combine technical skills with business acumen, and achieve outstanding results through strategic problem-solving is crucial for this position.
Primary Responsibilities:
- Accountable for end-to-end filings for all provider and facility contracts, amendments, templates, and health care benefit manager (HCBM) filings with the WA OIC and daily monitoring of regulatory response to filings.
- Reviews contractual documents and completes analyst checklists to ensure state and federal regulatory requirements are met. Communicates to internal stakeholders on changes necessary for contracts to be considered compliant.
- Prepares contract documents for filing ensuring finished contracts reflect Kaiser Permanente’s business, legal, regulatory, and reputational interests, including the following:
- Creates compliant SERFF filings for submission to the WA OIC. Develops filing description to accompany SERFF filings, anticipating issues, and positively influencing state regulator review.
- Coordinates with Kaiser Permanente’s regional and national provider contracting staff, Legal, Regulatory and Compliance departments to develop responses to active suspension comments from the regulator. Engages and coordinates input from appropriate subject matter experts to achieve timely and strategically appropriate responses.
- Analyzes, collaborates, and monitors, provider network management HCBM and related support of all associated WA OIC filings.
- Supports review and implementation of contract templates, ensures they are comprehensive, up to date and comply with the most current state and federal regulations, and makes available to staff for use in department’s Contract Management (CM) system.
- Assists with testing and validation of new contract templates in the CM testing environment prior to the release in CM production and participates in CM testing cycles for new system upgrades or enhancements as it pertains to the CM Library Manager functions.
- Supports a variety of priority contract compliance responsibilities, as assigned, including:
- Facilitation of internal audit, state, and federal audits/assessments (e.g., CMS, WA OIC).
- Corrective action plans.
- Regulatory contract amendments.
- Development of reporting and tracking data as it pertains to contract compliance initiatives and network adequacy.
- Works collaboratively with Provider Contracting staff to implement, monitor, and facilitate efficient contracting efforts and processes, and to ensure provider contracts meet regulatory, business, and reputational interests.
- Responsible for monitoring, managing, analyzing, and auditing contractual agreements, and their associated workflows, within department’s contract management (CM) system. Further responsible for creating reporting of department’s contractual agreements to ensure integrity and completeness of contract lifecycle, metadata and reportable information memorialized within CM and to raise awareness to dept. leadership and staff for any noted defects or areas of improvement.
- Identifies and recommends suggested enhancements regarding contract processes and CM system to potentially expand and strengthen its use and functionality.
Minimum Qualifications:
- Bachelor’s degree in business, legal, health care administration or equivalent experience.
- Five (5) years’ experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience providing the skills necessary for the position.
- One (1) year experience reviewing and interpreting laws and regulations, accreditation requirements (e.g., NCQA), analyzing business impacts and communicating to inform strategies.
- Ability to review and analyze complex documents, and regulatory requirements to identify potential issues/areas of non-compliance and spot any impacts to business-critical operations.
- Prior experience in provider contracting, insurance, or a related field would be a significant asset.
- Demonstrate adaptability and ability to succeed in a complex, demanding, and dynamic work environment.
- Capable of handling sensitive information with an elevated level of discretion and confidentiality.
- Proficient use of contract management and provider database software applications.
Preferred Qualifications:
- Three (3) years’ experience creating and submitting filings within the System for Electronic Rates & Forms Filing (SERFF) system.
- Eight (8) years’ experience in managed care contracting, legal administration or paralegal, health plan administration, or other comparable experience providing skills necessary for this position.
- Advanced knowledge of applicable federal and state laws and regulations related to healthcare (those pertaining to managed care contracting, network adequacy, NCQA, Medicare, Medicaid, and Washington Office of the Insurance Commissioner).
- Significant experience in the review and drafting of contract language, health plan operations (referrals, prior-authorization, product design) highly preferred.
About Northwest Permanente:
We are the Permanente in Kaiser Permanente. Northwest Permanente is a self-governed, multi-specialty group of 1,500 physicians, clinicians, and administrative professionals caring for 630,000 members in Oregon and Southwest Washington. Together with Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we form Kaiser Permanente of the Northwest, an integrated health care program. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Our Northwest Permanente administrative professionals enjoy a wide range of company sponsored benefits:
- 15% employer contribution to retirement programs, including pension
- 90% employer-paid health plan
- Tuition Reimbursement
- Child Care Benefits
- Flexible Work Schedules
- Paid Parental Leave
- Self-Care Days + Paid Time Off
For more information about this position, contact Marisa Walter, marisa.e.walter@kp.org.
Equal Opportunity Employer
Northwest Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
