Regulatory Compliance Specialist (Medicare / Medi-Cal)

Alameda, CA 94502 | Work from home flexibility

Posted: 05/02/2024 Category: Healthcare Job Number: ifierro20

Job Description

A-Line Staffing Solutions is Hiring a Regulatory Compliance Specialist for a Managed Care Client in the Easy Bay

 

*HYBRID*  After training, the goal is for the position to be onsite 1 day per week, and 4 days per week remote 

Summary

Under the direction of the Manager, Regulatory Affairs & Compliance, the Regulatory Compliance Specialist supports the compliance program by coordinating implementation of new and revised healthcare rules and requirements as are communicated by state agencies.

Principal responsibilities include:

  • Read, review and summarize prospective, new and revised rules and healthcare policy from local, state and federal agencies, including but not limited to, the Department of Managed Health Care (DMHC), the Department of Health Care Services (DHCS), and Centers for Medicare & Medicaid Services (CMS).
  • Coordinate with internal departments to gather data and information for regulatory submissions.
  • Schedule and lead meetings with stakeholders to review analysis, discuss key points, next steps, and potential issues affecting implementation.
  • Documents all actions taken by stakeholders to maintain a clear written record of the chronology of implementation for tracking and transparency.
  • Assist with the completion of CMS, DMHC and DHCS submission, amendments and material modifications related to all policy preparation, implementation and execution
  • Assist with internal information gathering as may be required during audits and other requests from state agencies.
  • Participate in and represent the Alliance at state agency and professional association meetings, trainings, conferences and webinars related to new regulatory mandates, regulatory updates, new member benefits and changes to existing member benefits
  • Participate in and represent the Compliance Department on internal committees and work groups related to prospective, new or revised legislation and policy work.
  • Assist in coordinating state and federal audit visits and complete responses.
  • Assist in the implementation of audit processes to ensure compliance with federal and state statutes and regulations and program guidance.
  • Research questions from staff regarding regulatory compliance.
  • Maintain knowledge of business products and related Alliance policies and procedures and alert the compliance staff of non-compliance risks.
  • Distributes the Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) All Plan Letters (APL) and other regulatory policy guidance to internal stakeholders in a timely manner.
  • Complete other special projects and duties as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

  • Communicating effectively and efficiently internally and externally.
  • Writing, reporting, researching, administration, and analysis.
  • Developing verbal presentations.
  • Leading and participating in internal and external committees and meetings.
  • Complying with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.


MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

  • Bachelor’s degree or equivalent experience required.
  • Familiarity with Medicaid (Medi-Cal), Medicare and other publicly funded programs preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

One-to-Three-year related experience in healthcare preferably in a managed care setting.


SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

  • Understanding of federal and state regulatory bodies and processes.
  • Proficiency in correct English usage, grammar, and punctuation.
  • Ability to communicate effectively, both verbally and in writing.
  • Exemplary interpersonal skills including ability to collaborate effectively as part of a team across organizational structure is a must.
  • Ability to ability to think critically, make informed decisions and work independently with minimal supervision.
  • Excellent organizational skills and orientation to detail.
  • Proven ability to prioritize and manage multiple projects simultaneously and meet deadlines.
  • Experience in use of computer system software such as MS Word, Excel, Access, Outlook, SharePoint, and PowerPoint.
  • Familiarity with SmartSheet and Team Dynamics (TDX) a plus.

To apply, please send your resume to Ignacio at Ifierro@alinestaffing.com 
 

#ALINE3

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