Compliance Manager

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.

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