PacificSource Health Plans

Human Resources

• Manage the administration of direct compensation including the processing, recording and reporting of compensation-related actions related to both salaried and hourly paid employees.
• Create consistent compensation guidelines and programs that match our compensation philosophy and organizational culture.
• Create and analyze job descriptions and wage grade classifications.
• Analyze and provide recommendations for new hire offers, promotions and internal transfers.
• Provide advice to management on pay decisions, policy and guideline interpretation, and job evaluation, including the design of creative solutions to specific compensation-related matters.
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database.
• Keep abreast of legal, regulatory and legislative trends that relate to corporate governance and compensation.
• Perform external market benchmarking analysis and internal equity analysis.
• Ensure that compensation practices are in compliance with current federal, state and local compensation laws and regulations.
• Assist Human Resources Team and other business partners throughout the organization with compensation-related issues.

Senior Compensation Specialist

• Manage the administration of direct compensation including the processing, recording and reporting of compensation-related actions related to both salaried and hourly paid employees
• Create consistent compensation guidelines and programs that match our compensation philosophy and organizational culture
• Create and analyze job descriptions and wage grade classifications
• Analyze and provide recommendations for new hire offers, promotions and internal transfers
• Provide advice to management on pay decisions, policy and guideline interpretation, and job evaluation, including the design of creative solutions to specific compensation-related matters
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database
• Keep abreast of legal, regulatory and legislative trends that relate to corporate governance and compensation
• Perform external market benchmarking analysis and internal equity analysis
• Ensure that compensation practices are in compliance with current federal, state and local compensation laws and regulations
• Assist Human Resources Team and other business partners throughout the organization with compensation-related issues
• Serve as a resource for hiring managers’ questions related to compensation
• Responsible for providing and maintaining compensation and benefit-related data in Workday HRIS system, ensuring the system is updated with appropriate information
• Keep abreast with trends and best practices in the field of compensation.

• Responsible for developing, administering, and maintaining compensation programs
• Partner with the business to enable attraction and retention of talent
• Evaluate requests to establish equitable and appropriate titles, salary ranges, pay rates, exemption assignments and benefit levels
• Manages projects related to compensation strategic initiatives
• Effectively collaborate with other members of the HR team
• Create consistent compensation guidelines and programs that match our compensation philosophy
• Analyze and provide recommendations for new hire offers, promotions and internal transfers
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database
• Ensure that compensation practices are in compliance with current federal, state and local compensation laws and regulations
• Serve as a resource for hiring managers’ questions related to compensation

• Manage the administration of direct compensation including the processing, recording and reporting of compensation-related actions related to both salaried and hourly paid employees
• Create consistent compensation guidelines and programs that match our compensation philosophy and organizational culture
• Create and analyze job descriptions and wage grade classifications
• Analyze and provide recommendations for new hire offers, promotions and internal transfers
• Provide advice to management on pay decisions, policy and guideline interpretation, and job evaluation
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database
• Ensure compliance with current federal, state and local compensation laws and regulations
• Serve as a resource for hiring managers’ questions related to compensation

• Responsible for developing, administering, and maintaining compensation programs which support our compensation philosophy.
• Partner with the business to enable attraction and retention of talent.
• Evaluate requests to establish equitable and appropriate titles, salary ranges, pay rates, exemption assignments and benefit levels.
• Manage projects related to compensation strategic initiatives.
• Effectively collaborate with other members of the HR team, and serve as a consultant to supervisors and staff across all locations.
• Manage the administration of direct compensation including the processing, recording and reporting of compensation-related actions related to both salaried and hourly paid employees.
• Create consistent compensation guidelines and programs that match our compensation philosophy and organizational culture.
• Create and analyze job descriptions and wage grade classifications.
• Analyze and provide recommendations for new hire offers, promotions and internal transfers.
• Provide advice to management on pay decisions, policy and guideline interpretation, and job evaluation, including the design of creative solutions to specific compensation-related matters.
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database.
• Keep abreast of legal, regulatory and legislative trends that relate to corporate governance and compensation.
• Perform external market benchmarking analysis and internal equity analysis.
• Ensure that compensation practices are in compliance with current federal, state and local compensation laws and regulations.
• Assist Human Resources Team and other business partners throughout the organization with compensation-related issues.
• Serve as a resource for hiring managers’ questions related to compensation.
• Responsible for providing and maintaining compensation and benefit-related data in Workday HRIS system, ensuring the system is updated with appropriate information.

• Responsible for developing, administering, and maintaining compensation programs which support our compensation philosophy
• Partner with the business to enable attraction and retention of talent
• Evaluate requests to establish equitable and appropriate titles, salary ranges, pay rates, exemption assignments and benefit levels
• Manages projects related to compensation strategic initiatives
• Effectively collaborate with other members of the HR team, and serve as a consultant to supervisors and staff across all locations
• Manage the administration of direct compensation including the processing, recording and reporting of compensation-related actions related to both salaried and hourly paid employees
• Create consistent compensation guidelines and programs that match our compensation philosophy and organizational culture
• Create and analyze job descriptions and wage grade classifications
• Analyze and provide recommendations for new hire offers, promotions and internal transfers
• Provide advice to management on pay decisions, policy and guideline interpretation, and job evaluation, including the design of creative solutions to specific compensation-related matters
• Participate in, and conduct salary surveys, including the analysis of survey data and maintenance of salary survey database
• Keep abreast of legal, regulatory and legislative trends that relate to corporate governance and compensation
• Perform external market benchmarking analysis and internal equity analysis
• Ensure that compensation practices are in compliance with current federal, state and local compensation laws and regulations
• Assist Human Resources Team and other business partners throughout the organization with compensation-related issues
• Serve as a resource for hiring managers’ questions related to compensation

Risk

• Assist in the accurate and comprehensive data submission to regulatory entities
• Collaborate and coordinate with internal and external partners
• Identify, analyze, interpret and communicate risk adjustment trends
• Responsible for maintenance of existing reports, development of new reports
• Validate data integrity and collaborate with technical teams
• Develop and maintain data sets leveraging internal data
• Demonstrate mastery in running all applicable risk models
• Maintain strict oversight of vendor partners
• Assist with all pertinent audits
• Develop, maintain, and report action metrics

Senior Risk Adjustment Analyst

• Assist in accurate and comprehensive data submission to regulatory entities such as CMS
• Collaborate and coordinate with internal and external partners to minimize submission errors
• Develop and improve processes related to risk adjustment and quality improvement
• Validate data integrity and collaborate with technical teams to improve data pipelines
• Report on actionable metrics related to risk adjustment and HEDIS®
• Provide mentorship to less experienced team members

Compliance

• Support all aspects of our Appeals and Grievance (A&G), Care Management (CM), and Utilization Management (UM) compliance program for Medicare, and Medicaid lines of business
• Assume the primary role of interfacing with the Compliance department, Auditors, Vendors and staff for purposes of monitoring and ensuring compliant operations
• Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting these departments
• Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance
• In partnership with Compliance staff and leadership, develop auditing and monitoring plans to assess compliance with all State, Federal and internal business rules and regulations
• Serve as an inter-departmental liaison for compliance and FWA activities
• Inform all business operations and workflow decisions to ensure that programs are compliant with State, Federal an internal business rules and regulations
• Be fully informed and ensure compliant processes are in place on all business operations, including but not limited to: business processes, OIG status, FWA programs, Helpdesk operations including call monitoring, Communication strategies, Website publications, Claims adjudication, and all vendor managed programs
• Maintain a current working knowledge of all applicable Medicare, and Medicaid rules and regulations including assessment, impact report and training on any new rules or regulations to all impacted departments
• Conduct frequent monitoring activities of all business operations, publish results and report out to Leadership, Compliance Department, quality committees and other PacificSource leadership teams as applicable
• Respond to all compliance related inquiries from internal Compliance Department Staff and external Auditors in a timely, professional and accurate manner to ensure minimal organizational and operational impact
• Work collaboratively with leadership to produce and monitor department policies and procedures as applicable and ensure their regular maintenance to reflect new practices and guidance
• Provide interpretation, training, and implementation of Medicare, and Medicaid regulations and communicate them appropriately with respective departments and teams
• Attending weekly meetings; review and approve external communications; and monitor operational performance reports
• Support ongoing communication efforts.
• Maintaining compliant members, departments, and provider communications
• Keeping letters and other member communications up to date with compliance guidance and best practices

Regulatory and Reporting Specialist

Clinician

• Collaborate closely with physicians, nurses, social workers, and a wide range of medical and non-medical professionals to coordinate delivery of healthcare services
• Assess the member’s specific health plan benefits and the additional medical, community, or financial resources available
• Provide utilization management (UM) services which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services
• Facilitate outstanding member care using fiscally responsible strategies
• Collect and assess member information pertinent to member’s history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services
• Coordinate necessary resources to achieve member outcome goals and objectives
• Accurately document case notes and letters of explanation which may become part of legal records
• Perform concurrent review of members admitted to inpatient facilities, residential treatment centers, and partial hospitalization programs
• Maintain contact with the inpatient facility utilization review personnel to assure appropriateness of continued stay and level of care
• Identify cases that require discharge planning, including transfer to skilled nursing facilities, rehabilitation centers, residential, and outpatient to include behavioral health, home health, and hospice services while considering member co-morbid conditions
• Review referral and preauthorization requests for appropriateness of care within established evidence-based criteria sets
• When applicable, identify and negotiate with appropriate vendors to provide services
• When appropriate, negotiate discounts with non-contracted providers and/or refer such providers to Provider Network Department for contract development
• Work with multidisciplinary teams utilizing an integrated team-based approach to best support members

Utilization Management Clinician – Tuesday - Saturday

• Collaborate closely with physicians, nurses, social workers, and a wide range of medical and non-medical professionals
• Assess the member’s specific health plan benefits
• Provide utilization management (UM) services promoting quality, cost-effective outcomes
• Facilitate outstanding member care using fiscally responsible strategies
• Perform concurrent review of members admitted to inpatient facilities

Utilization Management Clinician – Tuesday, Saturday

Associate

• Accurately and promptly enter and update provider demographic, credentialing, and contract information in PacificSource systems for new and re-credentialed network providers
• Process provider additions, terminations, and changes in a timely manner to maintain data integrity and ensure accurate contract rows are added for correct claims payments
• Perform regular audits of provider data to ensure accuracy, compliance with internal standards, regulatory requirements, and support ongoing maintenance and data integrity of provider information
• Assist in the management of provider directories, ensuring they are current, accurate, and meet the needs of members
• Verify licensure, Medicare, and Medicaid eligibility using compliance-approved tools
• Support the monitoring and maintenance of provider records for compliance with organizational policies, procedures, and contracting regulations
• Collaborate with Provider Relations, Credentialing, Contracting, and other internal teams to resolve provider data issues
• Communicate with providers to obtain necessary documentation or clarify discrepancies in data
• Provide support and assistance to other team members as needed
• Identify opportunities for process improvements related to provider data management
• Assist in the development and implementation of best practices for provider data entry and maintenance

Provider Network Data Maintenance Associate

Financial Planning and Analysis

• Responsible for the preparation of GAAP, statutory, and regulatory financial reporting
• Prepare monthly internal GAAP financial statements and management reporting package
• Prepare quarterly and annual NAIC statutory statements
• Prepare risk-based capital (RBC) calculations and regulatory filings
• Consolidate and analyze financial results across the group's entities
• Prepare, review, and post month-end journal entries
• Prepare quarterly and annual income tax provisions
• Own the income tax compliance workpaper-preparation
• Prepare and coordinate recurring indirect and local tax filings
• Research and respond to tax notices and agency correspondence
• Develop reports and perform validation and user-acceptance testing for Workday changes
• Identify and implement process improvement and automation opportunities

Senior Accountant, Financial Reporting and Tax

• Prepare monthly internal GAAP financial statements and the management reporting package for PacificSource and Subsidiaries
• Prepare quarterly and annual NAIC statutory statements and applicable state-required financial reports for the group's regulated entities
• Prepare risk-based capital (RBC) calculations, capital projections, and other regulatory filings for applicable entities under supervision of the Manager, Accounting & Regulatory Reporting
• Consolidate and analyze financial results across the group's entities in support of internal, statutory, and regulatory reporting
• Contribute substantively to annual external CPA statutory audits and ad-hoc regulatory financial examinations, preparing requested schedules and responding to auditor and examiner inquiries
• Prepare, review, and post month-end journal entries, including entries supporting consolidation, for internal GAAP and statutory financial statements
• Maintain and apply specialized statutory (SAP) accounting knowledge and serve as a resource to the broader team
• Prepare quarterly and annual income tax provisions on both GAAP (ASC 740) and statutory (SSAP 101) bases for the consolidated group

Senior Accountant, Financial Reporting, Tax

Investigator

• Independently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims.
• Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures.
• Proactively utilize available analytic resources to identify patterns of potential Fraud, Waste and Abuse, initiating audits when necessary.
• Conduct fact-finding interviews with internal staff, external providers, patients and other relevant parties regarding medical and behavioral health services initiating investigations when necessary.
• Utilize available Open Source Intelligence (OSINT) tools to verify provider licenses, research criminal history, disciplinary actions, financial assets and liabilities.
• Attend and participate in regional FWA Task Force and other state or federal meetings.
• Establish and maintain a comprehensive knowledge and understanding of current state and federal reporting requirements ensuring FWA reporting is received, summarized, catalogued, and disseminated to the appropriate agencies.
• Ensure regulatory reporting is developed, accurate, and submitted timely.
• Serve as an internal Subject Matter Expert (SME) on matters related to auditing and FWA.
• Develop and conduct internal FWA related training.
• Collaborate with government agencies during audits, investigations and Requests for Information (RFI).
• Present and discuss case findings and recommendations in case review meetings with department and company management.
• Participate in the development and presentation of FWA reporting for the Corporate Compliance Committee and the Audit and Compliance Committee of the Board.
• Coordinate and manage the production of investigative materials in support of settlement negotiations.

Senior Compensation Specialist

Senior Compensation Specialist

Senior Compensation Specialist

Senior Compensation Specialist

Senior Compensation Specialist

Senior Compensation Specialist

Senior Risk Adjustment Analyst

Senior Risk Adjustment Analyst

Regulatory and Reporting Specialist

Utilization Management Clinician – Tuesday - Saturday

Utilization Management Clinician – Tuesday, Saturday

Provider Network Data Maintenance Associate

Senior Accountant, Financial Reporting and Tax

Senior Accountant, Financial Reporting, Tax

Senior Investigator