Medical Compliance Specialist

Description The Compliance Specialist is responsible for supporting all compliance functions at the Health Plan. Lead the company's efforts to meet regulatory and compliance requirements and collaborate with internal departments and delegated entities. This position is responsible for the day-to-day administrative activities, coordination and communication between the company compliance auditors and delegated entities and reviewing and tracking all marketing materials.

Functions & Job Responsibilities

• Day to day coordination of all compliance administrative activities including but not limited to scheduling committee meetings, maintaining committee meeting minutes, following up on action items, maintaining Compliance Share Point, coordinating Compliance Week functions, other duties as assigned by Compliance Officer.

• Organize and maintain the compliance SharePoint site and filing system, compliance policies, audit tools, and work plan.

• Lead all communication between delegated entities and compliance auditors regarding audit engagement, progress, deliverable submission, and corrective action plan (CAP) implementation.

• Initial reviewer of all audit submission to ensure documents align with document request list.

• Ingest, file, and track HIPAA privacy concerns

• Annual audit scheduling and tracking

• HPMS regulatory memo maintenance and follow up

• Ingestion of all marketing material and assignment of material ID for tracking purposes. Support compliance marketing review and submit to CMS for file and use.

• Monitor, analyze, aggregate and report on data reported to the Plan.

• Understanding of basic audit and oversight procedures

• Administrative filing, scheduling, and organizing procedures

• Clear client communication skills to provide customers, internal and external, with detail oriented service

• Maintain an up-to-date knowledge of CMS requirements and HPMS portal.

• Collaborate with other departments and delegate entities on issues, audits, and corrective actions.

• Consult with Compliance Officer, as needed, to identify and resolve compliance and legal issues and concerns.

• Perform functions according to established policies and procedures, regulatory requirements, and applicable detail oriented standards. Requirements Education & Experience: · One (1) to three (3) years of Medicare Audit or Compliance experience. · Knowledge of Medicare Advantage CMS and California DMHC regulations. · Knowledge of HIPAA regulations required. · Valid driver's license and vehicle, or other approved means of transportation, and an acceptable driving record will be required for onsite audit work.

Skills: · Strong organizational skills: Ability to multitask and problem solving. · Experienced in interfacing with regulatory agencies, delegated entities, and internal stakeholders. · Presentation skills for training large and small groups. · Excellent verbal and written communication skills and ability to maintain positive relationships with providers, IPAs, and Plan partners. · Analytical and critical thinking skills are required. · Exhibit initiative and ability to assume responsibility and maintain confidentiality. · Advanced computer skills and experience with Microsoft Office Products.

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