Sr. Compliance Reporting Analyst

This role will be primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements. This role will also assist with data collection, analysis and reporting for process improvement efforts. 

The Sr. Compliance Reporting Analyst will plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.  Scope includes reviewing / auditing of all CMS required data tables, client-required or mandatory reports against applicable rules and regs. The Sr. Compliance Reporting Analyst position will also include quality assurance functions and quality improvement. 

• →Ensures compliance with regulations by examining and analyzing records, reports, operating practices, and documentation; will provide recommendations for improvement and coaching as necessary
• →Manages quality assurance for monthly ODAG universe submissions; reviews client validation results and ensures appropriate follow-up and closure of issues; manages any subsequent corrective actions and ensures appropriate root cause analysis is conducted. 
• →Review and manage the collation of quarterly Part C report and other client-required and mandatory report submissions; ensure timely communication of issues to process owners; track findings to resolution.
• →Completes audit work papers and memorandums by documenting audit findings
• →Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring.
• →Assists with non-clinical elements of client pre-delegation audits and accreditation.
• →Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings
• →Presents audit findings to stakeholders as needed
• →Analyzes quality assurance and compliance data and assists in preparing reports.
• →Assists in designing and implementing solutions to quality management issues.
• →Maintains a strong working knowledge of state and federal legislation, statutes and regulations, as well as various client service level agreements
• →Other tasks as assigned 

• Associate’s/Bachelor’s degree preferred or equivalent work experience.
• Minimum 2 years in a healthcare auditing, reporting or operations role
• Strong attention to detail and accuracy in fast-paced environment
• Strong oral and written communication skills
• Strong interpersonal and leadership skills
• Certification in Healthcare Compliance (CHC)
• Intellectual curiosity and ability to research issues, solve problems and develop solutions
• Ability to be flexible and evolve the role to accommodate new operational approaches
• Ability to generate new ideas, iterate on existing ones and identify trends & patterns that improve clinical quality and ensure compliance
• Ability to thrive in high-growth, rapidly changing health-tech environment
• Cross-functional collaboration skills 

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Team Interview & Live Exercise
4. Executive Interview 

*Subject to change

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.  To us, it’s personal.

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