Compliance Specialist

Requisition #20210
Employment Type

Full-time (Hybrid)

Experience

3-5 years prior experience in health plan environment

Required Degree

Bachelors degree or equivalent in Business Administration, Health Care or related field

Location

445 Grant Avenue, San Francisco, CA 94108

Region
Bay Area San Francisco
Application Email
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POSITION SUMMARY

The Compliance Specialist supports the efforts of the Compliance Officer to improve CCHP’s public presence and to provide excellent service to our existing and potential members, fellow employees, and business partners. With strong organizational skills, the Compliance Specialist assists the Compliance Officer in achieving the goals and objectives; identifies and resolves a variety of issues related to regulatory issues; maintains basic commercial regulatory files; develops and facilitates marketing materials; and prepares and submits Medicare/commercial marketing materials to federal and state regulators. This person has direct, daily contact with CCHP and Chinese Hospital managers, and other office staff persons.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Assists with regulatory filings into the Department of Managed Health Care (DMHC) and Centers for Medicare and Medicaid Services (CMS) protocols.
  • Assist the Compliance Officer to monitor the day-to-day compliance activities.
  • Assist with conducting the compliance risk assessment and assist with internal audit and monitoring activities.
  • Assist organization with internal, external, and regulatory audits.
  • Provide guidance and assistance to CCHP departments in statutory and regulatory requirements
  • Assist the Compliance Officer with responding to compliance hotline reports, department calls, reports of non-compliance, or other contacts. Assist with strategizing potential solutions and their implementation, including but not limited to compliance review spot-checks, training sessions, or policy revisions.
  • Perform ongoing compliance reviews to detect or confirm compliance violations.
  • Proactively cultivates and maintains strong, positive working relationships.
  • Maintains confidentiality of all information related to members, medical staff, employees, integrity issues, audits, and, as appropriate, other information.
  • Assists with or leads the development of compliant marketing materials.
  • Assists in performing presentations on educational trainings.
  • Stays knowledgeable and up-to-date with compliance of regulatory requirements.
  • Follows established and newly implemented changes in departmental policy.
  • Accepts and performs other duties as assigned.

QUALIFICATIONS

  • Bachelors degree or equivalent in Business Administration, Health Care or related field
  • 3-5 years prior experience in a health care environment
  • Certification in Healthcare Compliance is a plus
  • Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
  • Excellent time management, organizing and coordinating skills
  • Ability to make rational judgments on sensitive and confidential issues
  • Ability to set and change priorities quickly and as the situation warrants
  • Strong skills in Microsoft applications including MS Office: Word, Excel, PowerPoint, and Outlook
  • Follows directions carefully and completely
  • Works efficiently to maximize productivity
  • Strong written and verbal skills
  • Professional in manner and appearance

PHYSICAL REQUIREMENTS
• Able to lift up to 30 pounds
• Use proper body mechanics when handling equipment
• Standing, walking and moving 50% of the day.

In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require a medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.