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PacificSource Health Plans Corporate Compliance Specialist in Bend, Oregon

Overview

Responsible for supporting the Corporate Compliance Manager and Corporate Compliance Officer in administering the organization’s Corporate Compliance Program. This position is responsible for implementing Compliance Program strategies and initiatives at the direction of the Compliance Manager and Compliance Officer.

Responsibilities

  • Conduct investigations on compliance and fraud, waste and abuse (FWA) matters.

  • Participate in the development of compliance audit protocols and tools that will be used to conduct internal compliance audits of operational areas.

  • Lead internal compliance audits of operational areas.

  • Participate in developing the annual Compliance Work Plan, which includes conducting a risk assessment and assessing the overall risk to the organization.

  • Identify and assist in resolving areas of noncompliance.

  • Provide interpretation of rules and regulatory guidance for the organization.

  • Maintain current knowledge of changes in industry rules and regulations and effectively communicate with other departments to ensure these changes are disbursed appropriately.

  • Assist in the development, initiation, maintenance and updating of policies and procedures for the general operation of the Compliance Program. Assist with implementation of day-to-day operation of the Program.

  • Identify potential areas of vulnerability and risk, develop and oversee corrective action and improvement plans for areas of noncompliance, and provide general guidance on how to avoid or deal with similar situations in the future.

  • Assist with the development and implementation of an effective compliance training program, including appropriate introductory training for new employees and ongoing training for all employees, managers and the Board of Directors.

  • Collaborate with other departments to direct compliance issues through appropriate channels for investigation and resolution.

  • Development of monthly, quarterly and annual reports to regulatory agencies as required.

  • Assists Compliance Manager and Compliance Officer in responding to alleged violations of rules, regulations, policies, procedures and Code of Conduct.

  • Act as an independent review and evaluation body to ensure that compliance issues and concerns are being appropriately evaluated, investigated, and resolved.

  • Monitor, and as necessary, coordinate compliance activities of other departments in order to remain aware of the status of all compliance activities related to the organization’s business and to identify trends.

  • Participate in maintaining an effective compliance communication program relating to the organization’s government lines of business, including promoting:

  • Use of the fraud and abuse hotline;

  • Heightened awareness of Code of Conduct;

  • Understanding of new and existing compliance issues and related policies and procedures.

Supporting Responsibilities:

  • Participate in Compliance Program initiatives as needed.

  • Perform day to day tasks of the compliance department as needed.

  • Meet department and company performance and attendance expectations.

  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

  • Perform other duties as assigned.

Qualifications

Work Experience:Minimum 3 years of experience in the healthcare or health insurance industry required. Specific experience in Medicare and Medicaid compliance preferred.

Education, Certificates, Licenses:Associate’s degree in Business, Finance, or a related field or high school degree and equivalent work experience. Bachelor’s degree preferred.

Knowledge:Excellent written and verbal communication skills. Ability to clearly communicate with co-workers. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Strong research, analysis, organizational, and interpretative skills. Requires ability to define and prioritize problems and manage workload without direct supervision. Ability to gain a thorough understanding of PacificSource Government Programs initiatives. Extensive knowledge of Medicare and Medicaid laws and regulations affecting our business. Respond timely to regulatory inquiries. Ability to communicate effectively with CMS, OHA and other regulatory agencies, when needed. Keep Government Programs informed of new regulatory developments. Maintain sufficient reference materials to adequately research compliance issues. Working knowledge of medical terminology. Ability to read and understand health contract and benefits language. Ability to work under time pressures, meet strict deadlines, and to deal with emotional situations.

Competencies

Our Values

  • Adaptability

  • Building Customer Loyalty

  • Building Strategic Work Relationships

  • Building Trust

  • Continuous Improvement

  • Contributing to Team Success

  • Planning and Organizing

  • Work Standards

  • We are committed to doing the right thing.

  • We are one team working toward a common goal.

  • We are each responsible for our customers’ experience.

  • We practice open communication at all levels of the company to foster individual, team and company growth.

  • We actively participate in efforts to improve our communities-internal and external.

  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

Environment:Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Physical Requirements: Stoop and bend.Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

Disclaimer:This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Job ID2019-568A

TypeRegular Full-Time

of Openings1

StatusExempt

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