Job Details |
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| Compliance Specialist - Remote | |
| Job ID: | 00004JKN |
| Category: | AdminClerical |
| Location: | CA Camarillo |
| Hours: | 40 Monday to Friday 8am to 5pm |
| Pay: | $22.00 $28.00 |
| Remote Compliance Specialist Needed | |
| Job Description The Compliance Specialist helps to ensure that our Health Plan complies with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Develops, maintains, and updates or revises all audit tools as necessary. Plans for and coordinates efforts to evaluate internal compliance with policies, procedures, regulations, standards and contract provisions. Conducts regular and ongoing review of all relevant standards, guidelines, waiver, contractual provisions or other regulations. Coordinates with appropriate departmental staff to ensure that regulations are appropriately implemented. Conducts focused audit or review activities and if required, analyzes results and makes recommendations to Privacy Officer with regard to corrective actions andor penalties or other activities that may be necessary to address issues. Oversees the implementation of corrective action plans, monitors internal staff to ensure appropriate compliance with corrective action plans and makes recommendations for their completion. Supports the Privacy Officer with interactions and responses to State and Federal representatives, as necessary, on compliance- related issues. Triage and coordinate calls, requests, inquiries and meetings with regulatory agencies and onsite staff. Coordinate training for HIPPA and Fraud, Waste and Abuse. Support and coordinate Fraud, Waste and Abuse Investigations. Support Legal Compliance Specialist activities. Other projects and duties as assigned. | |
| Skills Required HS Diploma or GED. 3+ yrs of exp in a managed care organization. Exp interacting with governmental requirements and regulations. Proficient in MS Office. | |
| Skills Preferred BA Degree in Health Care Administration or similar. Medi-Cal, Medicare or NCQA exp preferred. | |