Compliance Specialist (Medicaid / Medicare) - CA
Job Details
Experienced
Irvine, CA or Long Beach, CA - Irvine or Long Beach, CA
Full Time
None
Day
Legal
Description

The role of a Compliance Specialist is to ensure 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. Additionally, this role requires the ability to handle sensitive matters with the utmost discretion.

 

Essential Duties:

  • Serve as subject matter expert for requirements impacting LIBERTY’s lines of business, and as a compliance resource to functional areas.
  • Monitor, identify, summarize, and maintain a repository of applicable regulatory and contractual requirements.
  • Coordinate with functional areas to ensure implementation of new requirements.
  • Research and advise on ad hoc compliance related inquiries.
  • Review forms, including provider agreements, client agreements, business associate agreements, policies and procedures, member facing materials, etc. for compliance implications.
  • Coordinate LIBERTY’s annual risk assessment, workplan and testing program; maintain LIBERTY’s Compliance Plan, Code of Conduct, and related materials.
  • Aggregate, analyze and report on findings, including: identifying error trends and root causes, and making recommendations for performance improvement. Monitor compliance with corrective action plans through resolution.
  • Ensure that compliance training materials are up to date. Coordinate enterprise-wide, annual compliance training.
  • Coordinate all aspects of vendor management, including onboarding and delegated oversight.
  • Coordinate all aspects of HIPAA compliance program, including incident management program.
  • Prepare and submit timely and accurate regulatory filings (for example, licensing renewals) and compliance attestations.
  • Develop and maintain a compliance dashboard, weekly compliance status summaries, compliance status tracking tools, etc.
  • Coordinate all aspects of quarterly Compliance Committee and related subcommittees, and prepare compliance reports for Board of Directors meetings.
Qualifications

Education and/or Experience:

  • A minimum of a BA degree and relevant industry certifications, or equivalent experience
  • 2-5+ years of progressive regulatory compliance and oversight experience
  • Direct experience in government managed or regulated healthcare (Medicaid / Medicare)
  • Experience in compiling, coordinating, analyzing, and organizing regulatory requirement data
  • Experience with compliance audits and assessments
  • Experience working for a health or dental insurance plan highly preferred
  • Heavy writing / composition experience

Specific Skills/Knowledge:

  • Strong to expert computer skills – specifically, MS Office (Excel, Word, PowerPoint) and SharePoint
  • Excellent critical thinking and problem solving skills
  • Effective oral and written communication skills at all organizational levels
  • Ability to manage multiple tasks and deliverables in a fast-paced environment

Environment and/or Physical Factors:

Work is generally performed within an office environment, with standard office equipment available. Sedentary work involves extensive sitting, typing, and close-range vision most of the time.

 

 

Sponsorship and Relocation Specifications:

LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.

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