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Cayuse Holdings
Compliance Specialist II
Central California Alliance for Health
full-time
Posted on:
Origin: • 🇺🇸 United States • California
Visit company websiteSalary
💰 $63,645 - $111,904 per year
Job Level
Mid-LevelSenior
About the role
- Reporting to the Compliance Manager
- 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 DHCS, DMHC, and 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
- Performs other duties as assigned
- Interprets requirements, mitigates risk, and holds stakeholders accountable to protect member access to quality healthcare
- Performs internal audits and monitoring and handles/investigates internal concerns related to HIPAA, fraud, waste, and abuse
Requirements
- 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
- Knowledge of the principles and practices of compliance programs and regulatory processes
- Knowledge of quality improvement practices and related audit techniques
- Knowledge of research, analysis, and reporting methods
- Knowledge of State and Federal legislative processes
- Ability to identify and research relevant legal materials, and analyze and interpret legal and contractual language
- Ability to learn and apply state and federal regulations related to compliance activities
- Demonstrated strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
- Bachelor’s degree in Business or Public Administration, Public Policy, Health Care Planning, or a related field (Master’s degree may substitute for two years of the required experience)
- Minimum of three years of compliance experience (a Master’s degree may substitute for two years); or equivalent combination of education and experience may be qualifying
- Applicants must be currently authorized to work in the United States; the Alliance does not provide sponsorship
