Especialista em Conformidade II

Aplicar

Localização: Remoto, Califórnia

We have an opportunity to join the Alliance as a Compliance Specialist in the Compliance Department. 

POR QUE VOCÊ SERÁ RESPONSÁVEL

Reporting to the Compliance Manager, this position: 

• Conducts regular on-going review and analysis of relevant contractual provisions and state and federal statutes and regulations
• Researches questions from staff regarding regulatory compliance and responds to external requests for information, including related to Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare & Medicaid Services (CMS) requirements
• Assists with the implementation of internal and external audit processes to ensure compliance with federal and state statutes and regulations and provides related program guidance for all lines of business
• Coordinates Alliance delegate oversight activities to ensure subcontractors' compliance with state, federal, and Alliance requirements
• Executa outras tarefas que lhe forem atribuídas

SOBRE A EQUIPE

The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization’s integrity and member access to quality healthcare. We are the team that helps employees understand and follow the complex rules and requirements to meet our important compliance obligations. In short, we define and support the Alliance's Culture of Compliance internally and with our external healthcare partners. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities.

O CANDIDATO IDEAL 

• Has experience working in a managed care or healthcare environment 
• Has knowledge of the Medi-Cal and Medicare Advantage programs and related regulations
• Is experienced in audits and monitoring, risk assessment, and/or delegate oversight
• Has an acute attention to detail and data accuracy 
• Has experience working remotely and knows how to self-motivate while staying closely connected to their team  
• Has excellent multitasking skills and thrives in a fast-paced environment 
• Is efficient with their time and can meet strict deadlines

O QUE VOCÊ PRECISA PARA TER SUCESSO

To read the full position description and list of requirements, Clique aqui. 

• Conhecimento de:
• The principles and practices of compliance programs and regulatory processes
• Quality improvement practices and related audit techniques
• Métodos de pesquisa, análise e relatórios
• Processos legislativos estaduais e federais
• Capacidade de:
  • Quickly understand Alliance roles and responsibilities related to oversight agencies
  • Identify and research relevant legal materials, and analyze and interpret legal and contractual language
  • Learn and apply state and federal regulations related to compliance activities
  • Demonstrar fortes habilidades analíticas e de pesquisa, identificar e solucionar problemas, identificar soluções alternativas e fazer recomendações para ação
• Educação e experiência:
  • Bachelor’s degree in Business or Public Administration, Public Policy, Health Care Planning, or a related field and a minimum of three years of compliance experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.

OUTRAS INFORMAÇÕES

• Estamos em um ambiente de trabalho híbrido e prevemos que o processo de entrevista ocorrerá remotamente via Microsoft Teams.
• Embora alguns funcionários possam trabalhar em regime de teletrabalho integral, será esperada a presença em eventos trimestrais da empresa ou em reuniões de departamento.
• Presença no escritório ou na comunidade pode ser necessária para algumas posições e depende da necessidade do negócio. Detalhes sobre isso podem ser revisados durante o processo de entrevista.

A faixa de remuneração completa para esta posição está listada por local abaixo. 

A remuneração real para esta função será determinada pela nossa filosofia de remuneração, análise das qualificações do candidato selecionado (experiência direta ou transferível relacionada ao cargo, educação ou treinamento), bem como outros fatores (equidade interna, fatores de mercado e localização geográfica).

Áreas típicas na Zona 1: Bay Area, Sacramento, área de Los Angeles, área de San Diego

Áreas típicas na Zona 2: área de Fresno, Bakersfield, Vale Central (com exceção de Sacramento), Califórnia Oriental, área de Eureka

Apply for Compliance Specialist II