Compliance Specialist - Managed Care
Job Details
Experienced
Irvine, CA or Long Beach, CA - Irvine or Long Beach, CA
Full Time
Day
Legal
Description

**Fast-paced and growing dental insurance company seeks a Compliance Specialist.

 

Opportunity to work in our **Irvine or Long Beach, CA** office.

 

The Specialist is responsible for ensuring LIBERTY’s compliance program meets regulatory and contractual standards for Commercial, Exchange, Medicaid, and Medicare lines of business. The successful individual must demonstrate integrity, credibility, strong interpersonal skills, and a command of regulatory requirements impacting government managed healthcare.

 

Essential Duties:

  • Serving as subject matter expert for requirements impacting LIBERTY’s lines of business, and as a compliance resource to functional areas.
  • Monitoring, identifying, summarizing, and maintaining a repository of applicable regulatory and contractual requirements.
  • Coordinating with functional areas to ensure implementation of new requirements. Leading development of new program materials and committees.
  • Reviewing forms, including provider agreements, client agreements, business associate agreements, policies and procedures, member facing materials, etc. for compliance implications.
  • Coordinating LIBERTY’s annual risk assessment, workplan and testing program; maintaining LIBERTY’s Compliance Plan, Code of Conduct, and related materials.
  • Aggregating, analyzing and reporting on findings, including: identifying error trends and root causes, and making recommendations for performance improvement. Monitoring compliance with corrective action plans through resolution.
  • Ensuring that compliance training materials are up to date. Coordinating enterprise-wide, annual compliance training.
  • Coordinating all aspects of vendor management, including onboarding and delegated oversight.
  • Coordinating all aspects of HIPAA compliance program, including incident management program. Supporting privacy and security compliance.
  • Preparing and submitting timely and accurate regulatory filings (DMHC, provider network contracts, licensing renewals, etc.) and compliance attestations.
  • Developing and maintaining a compliance dashboard, weekly compliance status summaries, compliance status tracking tools, etc.
  • Coordinating all aspects of quarterly Compliance Committee and related subcommittees, and preparing compliance reports for Board of Directors meetings.
  • Identifying opportunities and supporting efforts to influence a culture of compliance.
Qualifications

Qualifications:

  • **Strong to expert computer skills – MS Office (Excel, Word, PowerPoint)**
  • Advanced skills in MS Excel (e.g. pivot tables, macros, v-lookups, etc.) highly preferred
  • Bachelor's degree and relevant industry certifications OR equivalent experience
  • 2+ years of regulatory compliance and oversight experience preferred
  • Direct experience in government managed or regulated healthcare compliance (e.g. Medicare, Medicaid, DMHC, DHCS, CMS, etc.) preferred
  • Experience in compiling, coordinating, and analyzing regulatory requirement data preferred
  • Experience with compliance audits and assessments preferred
  • Excellent critical thinking and problem solving skills
  • Ability to effectively communicate at all organizational levels, both orally and in writing
  • Ability to manage multiple tasks and deliverables in a fast-paced environment

 

Sponsorship and Relocation Specifications:

LIBERTY Dental Plan is an Equal Opportunity Employer.

No relocation assistance or sponsorship available at this time.

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