Healthcare Administration - Compliance Manager

DOCS Management Services•Coos Bay, OR

12d•$3,077 - $3,654•Remote

About The Position

We are currently hiring a REMOTE Compliance Manager! If you are experienced in healthcare compliance and auditing, have a strong attention to detail, and value being part of a team that makes a difference, you may be the right person for the position! Apply today! JOB SPECIFICATIONS Classification: EXEMPT | Status & Schedule: FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED Work Location: OR, CA, AZ, TX, FL Salary: $3,076.95 - $3,653.85/bi-weekly Department: COMPLIANCE | Reports to: CHIEF QUALITY & COMPLIANCE OFFICER | Supervision Exercised: OVERSIGHT OF COMPLIANCE STAFF Job Purpose: Compliance Manager The Compliance Officer is responsible for a wide range of tasks to ensure DOCS and SWOIPA are in compliance with any, and all, relevant regulations and standards related to Medicaid Managed Care. The position is responsible for Compliance program implementation, oversight and management.

Requirements

Bachelor’s degree or equivalent in healthcare administration, business, or other related field of study required, Master’s level strongly preferred
Five years of relevant experience in law, ethics, organizational business, or healthcare required.
Healthcare auditing experience preferred
Current Healthcare Compliance Association or willing to work towards obtaining certification
Current Certified Professional Coder or willing to work towards obtaining certification
Must maintain ongoing core and specialized professional healthcare compliance and FWA knowledge, training, and education
Adept knowledge of federal and state regulations as related to Coordinated Care Organizations (CCO)
Thorough knowledge of research and investigation practices
Knowledge of Oregon Health Authority’s CCO contract for Advanced Health
Stay up-to-date on actual, proposed, or pending legislation and regulations that affect operations and identify operational obstacles to compliance
Capable of independent work, while at the same time open to accepting supervision and working effectively as the member of a team
Strong analytical and assessment skills
Strong interpersonal and professional communication skills, both orally and in writing
Clean, concise writing and presentation skills
Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
Skill in change management, conflict resolution, interpersonal relationship, quality management, systems thinking, teamwork, leadership, facilitation, and project management
Ability to conduct and implement ethical work practices
Ability to interview, investigate and enforce regulations firmly, tactfully, and impartially
Ability to work independently as well as with all levels of staff, members and external partners and vendors
Ability to handle a high-volume workload and effectively prioritize work to meet changing deadlines
Ability to take initiative, anticipate next steps, and be proactive
Ability to be flexible in a fast-paced environment and adaptable to change
Demonstrated professionalism and capacity to navigate a complex structure and respond to shifting and fluid priorities
Ability to report to work as scheduled, and willingness to work a flexible schedule when needed
Proficient in Microsoft Office Suite and Windows Operating System (OS)
Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access
Knowledge and understanding of how the positions’ responsibilities contribute to the department and company goals and mission
Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
Awareness and understanding of equity, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices
Excellent people skills and friendly demeanor
Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
Attention to detail and organization skills

Responsibilities

Compliance and Auditing Read, mark, learn, and inwardly digest federal, state, and contractual requirements related to Medicaid Managed Care
Oversee a distributive compliance program in which each department within the organization shares responsibility for assigned compliance functions
Provide technical assistance to internal departments, providers, and subcontractors, as requested
Develop, implement, and oversee annual audit plan for compliance with federal, state, and contractual requirements
Identify and report areas of risk and vulnerabilities and develop responsive procedures, disciplinary guidelines, and corrective action for external monitoring and reviews
Develop corrective action plans for findings resulting from contractor reviews
Assist in the development of corrective action plans for EQR reports that result in findings
Monitor corrective action plans until findings are fully resolved
Develop compliance program activities, including in-service training programs for board members, staff members, contractors, and providers, with particular emphases given to: (1) Fraud, Waste, and Abuse; (2) Program Integrity; (3) Certifications and Conflict of Interest; (4) Provider Selection and Exclusion; (5) Enrollee Rights and Protections; and, (6) the Patient Grievance System; (7) Human Resources; (8) HIPAA Privacy & Security; and, (9) Contracts
Oversee monitoring, auditing, and investigation to review significant findings, or trends, through internal and external processes, for the purposes of identifying and responding to potential risk or areas of non-compliance and engaging in corrective and preventative action
Review and enforce compliance policies and procedures to address areas of risk and to promote internal regulatory and contractual compliance
Participate in the review of complaints and reports of alleged non-compliance
Periodically analyze the resources assigned to compliance functions to ensure that such resources are adequate for maintaining an effective compliance program
Report on a regular basis to the compliance committee on matters involving the compliance program
Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies and/or officials, as appropriate or required
Participate in quality and organizational process improvement activities and teams when requested
Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
Handle confidential information and materials appropriately and maintain a secure work area
Other duties as assigned
Participate in quality and organizational process improvement activities when requested
Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
Advance personal knowledge base by pursuing continuing education to enhance professional competence
Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
Represent organization at meetings and conferences as applicable
Plan, orient and assign work to personnel that supports goals and objectives contained in the organization’s Strategic Plan and delivers outstanding team-based services
Promote a culture of risk-management, team-based, values-based, high-performance, and continually improving practice that values learning and a commitment to quality
Establish and monitor assigned staff performance, assign accountabilities, set objectives, and establish priorities
Ensure the completion of annual Development Reviews for assigned staff and recommend merit wage adjustments as appropriate, per policy
Assist in the recruitment, hiring, orientation, development, and evaluation of assigned staff to ensure
Promote employee retention, productivity, and satisfaction through ongoing support, encouragement, empowerment, coaching and effective teamwork
Ensure staff comply with approved organizational policy and procedure
Knowledge of federal and state employment and labor laws
Assist employees to read, interpret and apply policies and procedures
Support and mobilize assigned staff to engage in their assigned work through implementation of team building, performance coaching and problem-solving strategies
Ensure that staff is cross-trained to accomplish the goals and objectives of the organization
Responsible to back-up assigned staff workloads when necessary
Respond to the needs of direct and indirect staff with clear, open, and honest communication, mutual respect, and consistent follow through to generate trust and enhance personal effectiveness
Recommend discharge of employees, when indicated, based on work performance and behaviors
Demonstrated teaching ability and experience