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Compliance Specialist

Gold Coast Health Plan
Camarillo, CA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

POSITION SUMMARY

Under the direction of the Privacy Officer, the Specialist, Compliance, helps to ensure that Gold Coast Health Plan complies with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Under the guidance of the Privacy Officer, conducts compliance activities and processes.


ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

•    Develops and implements, processes, policies and procedures and other activities to ensure that Gold Coast is in compliance with State and Federal standards and requirements.

•    Develops, maintains, and updates or revises all audit tools as necessary. Under the guidance of the Privacy Officer’s plans for and coordinates efforts to evaluate internal compliance with policies, procedures, regulations, standards and contract provisions.

•    Conducts regular and ongoing review of all relevant standards, guidelines, waiver, contractual provisions or other regulations to which Gold Coast must comply. Coordinates with appropriate departmental staff to ensure that regulations are appropriately implemented by Gold Coast.

•    Under the guidance of the Privacy Officer conducts focused audit or review activities and if required, analyzes results and makes recommendations to Privacy Officer with regard to corrective actions and/or penalties or other activities that may be necessary to address issues.

•    Oversees the implementation of corrective action plans, monitors internal staff to ensure appropriate compliance with corrective action plans and makes recommendations for their completion.

•    Supports the Privacy Officer with interactions and responses to State and Federal representatives, as necessary, on compliance- related issues.

•    Triage and coordinate: calls, requests, inquiries and meetings with regulatory agencies and onsite staff.

•    Ability to work in a high stress environment and adhere to deadlines.

•    Assists with the development of contractual language, guidelines, standards or other requirements to ensure appropriate compliance to regulatory and other requirements.

•    Develop, maintain compliance 360 software.

•    Compliance committee recorder.

•    Coordinate training for HIPPA and Fraud, Waste and Abuse.

•    Responsible for compliance coverage when Privacy Officer is offsite.

•    Support and coordinate Fraud, Waste and Abuse Investigations.

•    Support Legal Compliance Specialist activities

•    Other projects and duties as assigned. POSITION QUALIFICATIONS Competency Statement(s)

•    Technical Aptitude - Ability to comprehend complex technical topics and specialized information.

•    Project Management - Ability to organize and direct a project to completion.

 

•    Strategic Planning - Ability to develop a vision for the future and create a culture in which the long range goals can be achieved.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.

•    Communication, Written - Ability to communicate in writing clearly and concisely.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.


SKILLS & ABILITIES

Education:    High School Graduate or General Education Degree (GED): Required

Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: Health Care Administration or related field.

Experience:    3 plus years of experience in in a managed care organization and interacting with governmental requirements and regulations.

Medi-Cal, Medicare and NCQA experience highly preferred.

Bachelor’s degree in Health Care Administration or related field or a combination of relevant work experience preferred.

Computer Skills:    Advanced computer skills included in the MS Office products.

Certifications & Licenses:

Other Requirements:

Knowledge of: Principles and practices of managed care.

Principles and practices of effective contracting and monitoring of the application of contracts. Knowledge of and experience with Federal and State regulatory and other requirements and practices related to Medi-Cal (Medicaid), Title 22, Knox-Keene, Medicare as well as other governmental and public sector operations and practices.


Gold Coast Health Plan

Address

Camarillo, CA
93010 USA

Industry

Business

View all jobs at Gold Coast Health Plan