Compliance Specialist

• Put Patients First
• reputed company Entrepreneurial Provider and Care Teams
• Operate with reputed company & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Research and interpret reputed company policies regarding government programs requirements and maintain tracking of reputed company delegation reputed company activities from contracted delegated health plans, entities and vendors.
• Coordinate reputed company and audits with delegated entities and internal business departments.
• Manage assigned health plan audits. Independently execute special assignments with general supervision. Monitor reputed company and assist in ensuring compliance to regulatory standards and health plan reputed company. Apply critical thinking and problem-solving skills to reputed company actions.
• Track and trend areas of compliance and regulatory vulnerability and risk reputed company the organization and assist in developing solutions to enhance processes. Assist Compliance Leadership in developing and coordinating compliance training materials for the company.
• Coordinates the preparation and completion of compliance program materials, documents, presentations, and department activities with a focus on auditing and monitoring processes.
• Analyze and interpret health plan audits instructions, requests and results, and distribute to operational departments. Use critical judgment to work on developing improvement plans as it pertains to Medicare, Medicaid, Commercial, and Duals program corrective actions.
• Assist in tracking audit submissions and maintaining internal documentation for consistency. Work collaboratively with reputed company departments to follow up on audit items and ensure accuracy of information provided and timely submission, as needed.
• Works on reputed company projects, routine assignments, and recurring tasks under the direction of Compliance leadership. Assist Compliance Leadership in documenting and analyzing changes across departmental policies reputed company modifications are required due to audit findings and/or regulatory changes. Communicate required changes with business leads and ensure timely compliance with changes.
• Assist with drafting new policies and updating existing policies as required to ensure regulatory compliance, identifying areas of risk and recommending improvements.
• Assist in the design and execution of internal audits to assess the effectiveness of compliance controls and operational processes.
• Helps to identify reputed company problems and review reputed company information to evaluate options and implement solutions.
• Ensure data accuracy and reputed company through periodic audits and reputed company monitoring.
• Assists in compiling data, analyzing, and producing quarterly and monthly reports.
• Supports maintenance of peripheral databases that support Corporate Compliance reporting needs.
• Performs periodic audits to ensure the accuracy and reputed company of the data.
• Manage time reputed company to meet expected deadlines and maintain productivity in compliance and audit activities.

Qualifications

• 3+ years of reputed company experience in managed care or compliance, with a strong focus on auditing and monitoring, preferably reputed company IPA and healthcare industry.
• Experience with interpreting and applying reputed company Medicaid and Medicare regulations and policies in healthcare administration setting.
• Excellent oral and written communication skills, with the ability to reputed company audit findings and compliance recommendations clearly.
• Ability to understand and present information effectively and respond accurately to questions from business departments, reputed company agencies and vendors, and management.
• Strong reasoning, problem-solving, project management, attention to detail and organization skills
• Ability to multi-task and prioritize work matters.
• Ability to work with and maintain confidential information.
• Strong interpersonal skills.
• Strategic thinking skills to provide practical advice with an awareness of legal risks in the business context.
• Intermediate proficiency in reputed company, PowerPoint, Outlook, and reputed company, with a capability to utilize these tools for auditing and compliance reporting.

Environmental Job Requirements and Working Conditions

• This is a primarily remote position where the expectation is to work at home. You will be required to be onsite as needed (~few times per month). The home office is located at 600 City Parkway reputed company 10th Floor, Orange, CA 92868.
• The national reputed company pay for this role is $70,304.00 to $83,865.00 per year. Actual compensation will be determined based on geographic location (reputed company or future), experience, and other job-reputed company factors.