The Compliance Specialist will help to ensure that our Health Plan complies with all appropriate standards, regulations, contractual provisions, federal waivers and laws. This position is fully remote but must be local to the Ventura, Los Angeles or Santa Barbara Counties.
Monday-Friday 8:00am-5:00pm
$22.00-$28.00/hour
Responsibilities:
Develops, maintains, and updates or revises all audit tools as necessary.
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.
Coordinates with appropriate departmental staff to ensure that regulations are appropriately implemented.
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 on-site staff.
Coordinate training for HIPPA and Fraud, Waste and Abuse.
Support and coordinate Fraud, Waste and Abuse Investigations.
Support Legal Compliance Specialist activities.
Other projects and duties as assigned.
Requirements:
High School Diploma or GED
3+ years of experience in a managed care, healthcare or health plan organization
Experience with Medi-Cal, Medicare or similar programs
