Compliance Specialist

Astiva Health•Orange, CA

7d•Onsite

About The Position

The Compliance Specialist will play a critical role in the development and maintenance of Astiva's Compliance Program. In this role, the Compliance Specialist will support the daily operations of the Compliance Program, implement proper preventative compliance programs, investigate complaints, and execute relevant policies and procedures to ensure all business units and activities meet state and federal regulations.

Requirements

Bachelor's degree, or equivalent career experience, required
Two (2) years prior experience at a Medicare Advantage Organization or Prescription Drug plan Sponsor
Knowledge of risk assessment concepts
Demonstrated understanding of CMS Medicare Guidelines.
Ability to work effectively and participate in a team environment.
Ability to handle and prioritize multiple tasks simultaneously.
Proficient in MS Word and Excel
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups and customers or employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

Responsibilities

Collaborate with internal stakeholders on Compliance issues.
Under the direction of the General Counsel/Compliance Officer, prepare reports, related analyses, and make recommendations to assist management in ensuring compliance and improvement of internal controls.
Consult with the legal department and advise leadership and management on compliance matters.
Develop and provide employee training on compliance policies, practices, and reporting systems.
Ensure compliance with state and federal agencies by studying existing and new legislation and facilitating the compliance program.
Provide guidance and information by interpreting policies and procedures related to compliance issues.
Conduct thorough investigations of sales allegations, identifying compliance concerns and documenting findings accurately.
Track complaints in the Medicare Compliance database and link all relevant documents.
Assist the Management team with internal reporting of complaints, including populating reports that demonstrate complaint volume and investigation statuses.
Identify, investigate, and report compliance issues, irregularities, and violations.
Maintain record of compliance activities.
Communicate with government agencies.
Assist in the preparation of compliance reports, including reports for the Board of Directors and Compliance Committee.
Handle all compliance and ethics matters with sensitivity and maintain strict confidentiality of all work material and activities.
Regular and consistent attendance
Other duties as assigned