Senior Healthcare Compliance Specialist

Advanced Health is a locally owned and operated Coordinated Care Organization (CCO) serving all Coos and Curry County communities.

We are searching for collaborative, innovative people committed to a shared community vision for health to join our team.

We are currently hiring a Senior Healthcare Compliance Specialist.

If you are inquisitive, ethical, creative, and and value being part of a team that makes a difference, you may be the right person for the position!

Apply today!

We are committed to offering:
Competitive wages
Competitive benefits
Paid Time Off (PTO)
Sick leave
Health and life insurance
FSA and HSA
401(k) retirement with generous employer match
Profit-sharing
Team-oriented atmosphere that values each of our employees as an individual and their work-life balance
Remote work options
Flexible scheduling

Every employee shares the responsibility for achieving the Quadruple Aim of health care reform: member engagement and satisfaction, improving quality of care, managing costs, and honoring diversity and equity.

By focusing on the people and communities we serve, we strive to ensure the dignity, privacy and confidentiality of members, their families, co-workers, and others.

All duties are performed in compliance with organization’s policies and procedure, contractual obligations, and within federal and state laws and guideline including HIPAA, OSHA, and Waste Fraud and Abuse regulations.

JOB PURPOSE: Senior Healthcare Compliance Specialist

This position is responsible for a wide range of healthcare compliance and auditing tasks to ensure Advanced Health is in compliance with any, and all, relevant regulations and standards related to Medicaid Managed Care.

The position is responsible for coordinating the compliance program implementation, oversight, auditing, and management.

ESSENTIAL RESPONSIBILITIES: Healthcare Compliance and Auditing
Read, mark, learn, and inwardly digest federal, state, and contractual requirements related to Medicaid Managed Care
Assist with the development, coordination, and administration of 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 subcontractor review 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 subcontractor 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
Assist in the development of, 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
Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
Handle confidential information and materials appropriately and maintains a secure work area
Work in coordination with the DOCS Compliance Department
Other duties as assigned
QUALIFICATIONS, EDUCATION, AND EXPERIENCE REQUIREMENTS
Bachelor’s degree or equivalent in healthcare administration, business or other related field of study required; advanced degree preferred
Minimum of 3 years relevant experience in law, ethics, organizational business, or healthcare
Healthcare auditing and investigative experience strongly preferred
Healthcare Compliance or Professional Coding certification required within one year of hire
KNOWLEDGE, SKILLS, AND ABILITIES
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.
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, equity lens, diversity, and inclusion
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
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
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 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
Proficient in Microsoft Office Suite
Non-judgmental attitude
Ability to report to work as scheduled
Ability to handle stress and sensitive situations effectively while projecting a professional attitude
Willingness to work a flexible schedule when circumstances necessitate
Ability to communicate professionally, both orally and in writing
Ability to work with diverse populations
Ability to relate to and interact with people of differing personalities and backgrounds
Sensitive to economic considerations, human needs and aware of how one’s actions may affect others
Ability to organize and work in a sensitive manner with people from other cultures
Poised; maintains composure and sense of purpose
WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.
Work Condition:
Employee generally works within the interior of an office environment.

Employee may travel locally and be responsible for own transportation.

Out of area travel may be required on occasion.

Hours of operations and specific staff scheduling may vary between worksite based on operational need.
The general environment is clean with a comfortable temperature and moderate noise level.

Exposed to: Cold/heat controls, close contact with employees and the general public.
Machines, equipment, tools and supplies used: Constantly operates a computer or other office productivity machinery, such as postage machine, fax, copier, calculator, multi-line telephone system, scanner
May answer a high volume of telephone calls, complete documentation, and use computer programs to either obtain or record information
Multiple Duties: Must be able to work under conditions of frequent interruption and be able to stay on tas

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