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Compliance Specialist

Requisition #

20373

Location

San Francisco Bay Area

Employment Type

Full-Time, Hybrid (2 Days in Office)

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 & Responsibilities

  • Assists with regulatory filings into the Department of Managed Health Care (DMHC) and Centers for Medicare and Medicaid Services (CMS) protocols.
  • Assists the Compliance Officer to monitor the day-to-day compliance activities.
  • Assists with conducting the compliance risk assessment and assist with internal audit and monitoring activities.
  • Coordinates and/or manages the response to, and investigation of, privacy and security incidents and breaches of protected information; provide guidance or technical assistance and follow-up on mitigation and corrective action activities.
  • Coordinates activities related to the implementation of compliance and privacy mandates (i.e., Federal and State laws and regulations including privacy and FWA risk assessments, audits, and the preparation of reports / metrics / dashboards.
  • Extracts data, notices, as required, in DMHC Systems (e.g., Timely Access Reporting, etc.).
  • Under the supervision of the Compliance Officer, research, analyze, and interpret laws, regulations, and contracts; develop, review, and update policies and procedures; conduct routine or focused reviews for adherence to State, and local (Covered California) regulatory and contractual requirements, as well as organizational needs. – DMHC & DHCS /State and Accreditation (NCQA).
  • Assists organization with internal, external, and regulatory audits.
  • Provide guidance and assistance to CCHP departments in statutory and regulatory requirements
  • Assists 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.
  • Performs 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
  • Two years prior experience in a health care environment
  • 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.

Compliance requirements

Complies with CCHP Compliance Handbook including Code of Ethics and all statutes, regulations, guidelines applicable to federal and state programs. Responsibilities include, following the guidelines and reporting suspected violations of any statute, regulations, agreements or guidelines applicable to all healthcare programs.

Base Pay Scale

Starting at $26.50/hour – $40.80/hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.