Compliance Analyst

Title: Compliance Analyst

Reports to: Director of Evaluation \& Impact

Directly Supervises: None

Summary of Job:

This job requires a motivated self\-starter who is interested in evaluation, finance, organizational metrics, reporting, and data quality in a mission\-driven organization. The Compliance Analyst plays a critical role in supporting our organization’s work with California’s Enhanced Care Management (ECM) benefit and other key initiatives. This position is housed within the Evaluation team and will be responsible for overseeing processes related to ECM claims submission and billing, data collection, data integrity, and compliance monitoring. Central to this role will be a strong understanding of the requirements and regulations involved in ECM and other active initiatives, the ability to ensure that HPP remains in compliance with those requirements and regulations, and active maintenance of a schedule of reporting requirements. The ideal candidate will have experience with Medi\-Cal or similar programs, strong analytical and organizational skills, and commitment to advancing high\-quality, equitable care.

Essential Duties and Responsibilities:

Claims and Billing Oversight

• Refine and maintain an ECM billing workflow, including claim submission timeline, documentation standards, and payment reconciliation processes.
• Coordinate with internal teams (e.g., finance, programs, IT) and external stakeholders (e.g., managed care plans, billing vendors) to ensure timely and accurate claims submission.
• Track billing and payment data to identify discrepancies and ensure accurate reimbursement for services rendered.
• Work with the billing vendor to troubleshoot claims issues and create corrective action plans.

Data Collection and Integrity

• Develop and maintain systems for capturing, storing, and reporting on ECM\-related data, including encounter data, demographic information, and service delivery metrics.
• Monitor Eligibility file submissions from the Health Plan and ensure timely updates are submitted each month through the Enrollment file.
• Conduct regular audits of submitted data to ensure accuracy, completeness, and alignment with contractual and regulatory requirements.
• Collaborate with staff to improve data entry practices and streamline reporting processes.

Contract and Regulatory Compliance

• Maintain documentation of policies, procedures, and workflows relevant to ECM compliance.
• Monitor compliance with ECM contracts, including managed care plan requirements and DHCS guidelines.
• Prepare and submit monthly Health Plan audits and biannual DHCS audits.
• Stay informed regarding regulatory changes, and update internal systems and processes accordingly.

Reporting and Analysis

• Prepare and submit required reports to funding agencies, managed care plans, and internal stakeholders.
• Analyze service utilization, billing patterns, and other performance indicators to inform strategic decisions and continuous quality improvement.
• Support internal stakeholders with reports and data requests related to program performance and compliance.

Internal and External Collaboration

• Serve as a liaison between the Evaluation team, Finance department, program teams, IT/data systems, and external partners to ensure ECM operations run smoothly.
• Provide training, technical assistance, and support to staff on documentation, compliance, and data integrity.
• Participate in relevant workgroups, trainings, and learning collaboratives to share knowledge and strengthen organizational capacity.

Program Evaluation

• Support implementation of HPP’s Theory of Change and mission alignment initiatives by providing reporting, analysis, and training support as needed.
• Work with the Program Evaluation team to evaluate HPP’s program models and provide regular support for HPP’s direct service teams, including capacity reports, service and outcomes monitoring, and others as requested.
• Lead continuous quality improvement (CQI) efforts as needed. This entails planning and facilitating CQI meetings, as well as identifying appropriate service and outcome metrics, monitoring service provision and outcome achievement, and collaborating with program management to ensure high quality of services.

Special Projects/Trainings/Initiatives

• Support the Evaluation and Finance Departments with strategic projects and initiatives, and lead projects as requested.
• Work closely with program management and staff to ensure effective and timely rollout of any changes to program implementation or Salesforce documentation.
• Prepare accurate and concise reports on projects that are often time\-sensitive and deadline\-driven.
• Support staff in learning new processes/procedures through training and one\-on\-one support.

Core Competencies:

All HPP Staff are expected to meet the expectations of our Core Competencies:

* Accountability and Reliability: Shows up for the team, the clients, and the organization; takes responsibility for actions, and follows through on tasks and projects.

* Collaboration: Helps colleagues as needed, views responsibilities as shared; Actively participates in agency\-wide initiatives/ efforts.

* Communication: Uses effective written and oral communication with coworkers and community served; understands emotions of self and others, and responds with empathy.

* Continuous Learning: Demonstrates curiosity and eagerness to learn and develop professionally.

* Equity Mindset: Understands and is committed to goals of diversity, equity, and inclusion and fostering an inclusive environment; consistently centers equity in the organization’s work both internally and externally.

* Proficiency in area of focus: Has skills and knowledge in role and area of focus.

Qualifications:

• Bachelor’s or Master’s degree in public health, public policy, education, finance, social work, or a related field, or the equivalent of four years of comparable work experience.
• Demonstrated ability to think critically, systematically, analytically and logically.
• Comfort and interest in working with data and contract reporting.
• Effective written and oral communication, with exceptional organizational skills.
• Proficiency with Microsoft Word and PowerPoint, as well as Google Suite.
• Advanced knowledge and effective use of Microsoft Excel, including formulas used for analysis.
• Experience with Salesforce or other database management systems.
• Willingness to learn with a strong drive towards independent problem solving and finding effective solutions.
• Ability to maintain appropriate professional and personal boundaries with high integrity.
• Understanding of, and commitment to, anti\-racism, social justice, and HPP’s mission and organizational values.

Preferred: HPP recognizes the value of having a staff that brings a wide range of perspectives to this work based on language, ethnicity, race, gender, socio\-economic background, political beliefs, sexual orientation, and disability. We are committed to maintaining a diverse, multicultural working environment and particularly encourage applications from candidates with lived experience in the communities we seek to serve.

Physical Requirements: This position requires the ability to work under stress and handle multiple project deadlines. This position requires an annual tuberculosis test and may require moderate lifting.

Work Environment: Fast\-paced, multicultural, collaborative work environmentHours: 39 hours/week

Salary: $83,215 starting \+ excellent benefit package

FLSA Status: Non\-exempt

About HPP

Founded in 1989, the Homeless Prenatal Program (HPP) is a nationally recognized family resource center in San Francisco that empowers homeless and low\-income families, particularly mothers motivated by pregnancy and parenthood, to find within themselves the strength and confidence they need to transform their lives.

HPP helps families become healthy, stable and self\-sufficient. We focus on the social determinants of health, supporting both parents and children in order to strengthen the whole family. With services ranging from emergency support to intensive case management, the agency partners with parents to address family needs during the critical years from pregnancy through kindergarten.

The first agency in San Francisco to hire former clients as staff, HPP’s evolution has been guided by the community it serves. More than half of HPP’s immensely talented staff of 125\+ come from the community and/or are graduates of the agency’s Community Health Worker Apprenticeship Program, which trains individuals for careers in the nonprofit sector.

Over the years, HPP has received considerable recognition for its service to the community. In 2022, we were named “Nonprofit of the Year” by the San Francisco Chamber of Commerce, and our work has been highlighted by The New York Times, CNN, KQED, The Huffington Post, People and The San Francisco Chronicle. Additionally, HPP receives consistently high ratings by leading philanthropic evaluators such as Guidestar and Charity Navigator.

The Homeless Prenatal Program is an Equal Opportunity Employer and provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Pay: From $83,215\.00 per year

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Application Question(s):

• What interests you about this position and working at Homeless Prenatal Program?
• How do you stay up to date with changing regulations and ensure compliance?

Education:

• Bachelor's (Preferred)

Experience:

• Data management: 2 years (Preferred)
• Compliance management: 2 years (Preferred)
• Quality audits: 2 years (Preferred)

Ability to Commute:

• San Francisco, CA 94110 (Required)

Work Location: Hybrid remote in San Francisco, CA 94110