Description

Job Summary

Support the Compliance Department and Compliance Staff in meeting regulatory requirements through the preparation and filing of reports and related information required by state agencies through audits and requests; and by assisting in the development and maintenance of an enterprise-wide compliance program. This position reports to the department manager.

Duties and Responsibilities

• Assists in the preparation and filing of recurring and ad-hoc reports required to be submitted to the state Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and other agencies as necessary
• Assists with the maintenance of a Knox-Keene License and all necessary modifications and amendments to that license
• Assists in the development and maintenance of policies and procedures consistent with regulatory and state contract requirements and current industry standards
• Assists in the implementation of audit processes to ensure compliance with federal and state statutes and regulations and program guidance
  • Assists in the development, implementation and maintenance of the compliance audit program and risk assessment
  • Conduct enterprise-wide audit to evaluate Plans compliance with state and federal laws, regulations and policies
  • Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations
  • Communicate to key stakeholders regarding audit findings and corrective actions, if necessary
• Other related projects and duties as may be required

Primary external contacts include State Department of Managed Health Care, State Department of Health Care Services, other County Organized Health Systems and Medi-Cal plans and industry organizations such as the California Alliance of Health Plans and the Association of Health Insurance Plans.

Qualifications

Skills/Knowledge/Abilities

• Understanding of basic principles of Medi-Cal and managed care
• Understanding of federal and state regulatory bodies and processes
• Understanding of CenCal Healths operations and processes a plus
• Ability to effectively prioritize multiple tasks and deadlines
• Ability to effectively, clearly and independently document, summarize and resolve complex issues
• Ability to analyze and interpret regulatory and contractual requirements
• Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position
• Ability to develop and organize electronic and paper filing systems
• Ability to communicate accurately and effectively, both orally and in writing
• Ability to establish and maintain effective and cooperative working relationships with management and staff
• Ability to work under pressure to accurately complete tasks within established deadlines

Education and Experience

• One (1) year experience in the health care field (preferably in a managed care setting)
• Must have experience and knowledge with Internal Audit Standards
• Must have experience researching, compiling and organizing information from various sources
• Experience working with regulatory agencies desirable; basic knowledge of Medi-Cal and Knox-Keene requirements preferred
• Knowledge of and proficiency in the use of Microsoft Word, Excel and PowerPoint software
• Comfortable with learning to use new computer systems as necessary to support Compliance programs
• Attention to detail and accuracy a must.