Under the general supervision of the Director of Compliance, this position is responsible for supporting the Alameda Alliance for Health’s Compliance program for all lines of business.
Principal responsibilities include:
• Identify and develop Alliance policies and procedures with strong working knowledge of policy development and approval process.
• Collaborate with senior level staff in developing annual risk assessments and translating identified risks into a work/audit plan.
• Audit various department processes and develop audit tools, audit reports, and criteria metrics.
• Creating audit tools, data and summary reports to present to management and committees
• Consult in the development and monitoring of corrective action plans to mitigate risks.
• Coordinating external audits,
EDUCATION OR TRAINING EQUIVALENT TO:
• Bachelors of Arts or Bachelors of Science degree required.
• Health plan or managed care experience preferred.
• Certified in Healthcare Compliance (CHC) is preferred.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
• Three years experience in managed care, health care compliance/operations, audit, regulatory, investigation, and/or medical group experience.
• Supervisory experience preferred.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
• Exemplary interpersonal skills, including ability to work effectively as part of a team across organizational structure a must.
• Ability to analyze and interpret legislative, statutory, regulatory, and legal language.
• Analytical problem solving skills with initiative and ability to work independently.
• Ability to meet deadlines and adjust to changes in policies, procedures, and priorities.
• Effective verbal and written communications skills.
• Knowledge of managed care regulations and HIPAA regulations.
• Medicare compliance experience is a preferred but not required.
• Familiarity with Medicaid (Medi-Cal) and other publicly funded programs.
• Strong project management background with working knowledge of compliance principles and theories.