Compliance Analyst Regulatory Affairs

SAN JOAQUIN COUNTY HEALTH COMMISSION•French Camp, CA

9d•$73,000 - $105,000•Remote

About The Position

Under general supervision, this role is responsible for the coordination, assessment, research, analysis, maintenance, and auditing of key compliance matters within the Health Plan. This is a remote position, and candidates must reside in California, preferably within the service areas. The Health Plan does not sponsor visas, so candidates must have legal and valid work authorization, a Green Card, or U.S. citizenship.

Requirements

In-depth knowledge of federal and state regulations and standards, including False Claims Act as it relates to compliance in health care.
In-depth knowledge of managed care health plan functions and interactions as they relate to compliance.
In-depth knowledge of contracting regulations and best practices.
Basic knowledge of ICD-10 and CPT coding and medical terminology, and industry standard payment practices.
In depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
Strong analytical skills, including the ability to perform routine analysis, using identified data, information and/or issues, and provide recommendations.
Produces work that is accurate and complete.
Produces the appropriate amount of work.
Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
Rebounds from setbacks and adversity when facing difficult situations.
Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
In-depth knowledge of basic data analysis tools and techniques, with ability to analyze and interpret data.
Strong problem-solving skills, with the ability to identify and resolve problems of moderate complexity.
Strong research skills with the ability to identify and review complex materials to develop and evaluate options and propose solutions.
Strong organizational and project management skills, with the ability to prioritize and complete a variety of tasks and prioritize work of others.
Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of HPSJ; the ability to effectively explain complex information and document according to standards.
Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
Time management: Uses time effectively and efficiently; values time; concentrates his/her efforts on the more important priorities; can attend to a broader range of activities; meets deadlines.
Strong leadership skills, with the ability to influence without authority, establish direction, build alliances and motivate others.
Commitment to and ability to facilitate the adoption of HPSJ’s strategy, vision, mission and values.
Strong mathematics skills, including the ability to calculate ratios, perform simple algebra and statistical formulas.
Intermediate skills in Word, Excel, Power Point, Visio and Project.
Ability to speak and be understood in English.
Ability to handle confidential information with appropriate discretion.
Bachelor’s Degree; and at least three years of experience reading, analyzing and interpreting State and Federal laws, rules and regulations; or Equivalent combination of education and experience.

Nice To Haves

Basic skills in reporting software, such as Tableau, with ability to present data in consumable formats such as charts and graphs.
Experience as a Compliance Data Analyst in a Medi-Cal managed care plan
Certified in Health Care Compliance.

Responsibilities

Supports the development and renewal of state contracts and contract amendments, including coordination, verification, writing revisions of the EOC and submitting to the state.
Conducts or assists in conducting risk assessments of HPSJ’s business practices and determining areas of exposure; recommends mitigation plans as needed.
Conducts research and analysis on contractual and regulatory requirements with respect to HPSJ and delegated vendors.
Maintains the compliance audit program, including schedules, standards, processes, reports and tools in close collaboration with the Compliance management.
Conducts and coordinates routine and ad-hoc internal and external audits and identifies gaps that require corrective action plans.
Coordinates or manages implementation of internal and external corrective action plans, monitoring progress and completion, coordinating interviews and document gathering; escalates as required.
Provides guidance to internal and external stakeholders to ensure understanding and compliance with regulatory, contractual and accrediting requirements, and organization policies and procedures.
Leads the compilation and tracking of deliverables; reviews deliverables for accuracy and facilitates corrections; obtains appropriate approvals and submits deliverables according to timelines.
Evaluates financial impact of identified compliance issues, and reports findings.
Develops and maintains routine and ad hoc Compliance Reporting, including but not limited to detailed and summary level reporting via written interpretation of analytical results to present to internal and external stakeholders.
Enters and maintains data, information, documents and files according to standards, including but not limited to compliance software.

Benefits

Robust and affordable medical coverage including HMO and PPO plan options
Employee Wellness Program promoting physical, mental, and financial well-being
Dental and vision plan with multiple provider choices
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, plus a voluntary defined contribution plan
Two flexible spending accounts (FSAs)for healthcare and dependent care expenses
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Assistance Program (EAP)
Health Advocacy to help you navigate medical care and benefits
Voluntary supplemental benefits including medical, legal, identity theft protection
Online discount mall
Tuition reimbursement
Remote work contingent on business needs and company guidelines
A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do