Compliance Specialist

$45,760 - $58,240/Yr

Unclassified - Camarillo, CA

Full-time

Remote - Camarillo, CA

About the position

The Compliance Specialist will play a crucial role in ensuring that the Health Plan adheres to all relevant standards, regulations, contractual provisions, federal waivers, and laws. This position is primarily remote but requires the candidate to be local to Ventura, Los Angeles, or Santa Barbara Counties. The role involves a variety of compliance-related tasks, including audits, training, and coordination with regulatory agencies.

Responsibilities

• Develops, maintains, and updates or revises all audit tools as necessary.
• Plans for and coordinates efforts to evaluate internal compliance with policies, procedures, regulations, standards, and contract provisions.
• Conducts regular and ongoing review of all relevant standards, guidelines, waivers, contractual provisions, or other regulations.
• Coordinates with appropriate departmental staff to ensure that regulations are appropriately implemented.
• Oversees the implementation of corrective action plans, monitors internal staff to ensure appropriate compliance with corrective action plans, and makes recommendations for their completion.
• Supports the Privacy Officer with interactions and responses to State and Federal representatives on compliance-related issues.
• Triage and coordinate calls, requests, inquiries, and meetings with regulatory agencies and on-site staff.
• Coordinate training for HIPAA and Fraud, Waste, and Abuse.
• Support and coordinate Fraud, Waste, and Abuse Investigations.
• Support Legal Compliance Specialist activities.
• Other projects and duties as assigned.

Requirements

• High School Diploma or GED
• 3+ years of experience in a managed care, healthcare, or health plan organization
• Experience with Medi-Cal, Medicare, or similar programs