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Compliance Specialist, Santa Barbara, CA


Organization: CenCal Health
Category: Professional
Location: Santa Barbara, CA
Date Job Posted: October 12, 2020
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Compliance Specialist

Job Category: Administrative
Requisition Number: COMPL01272

Job Details

Description

  • Assists in the preparation and filing of recurring and ad-hoc reports required to be submitted to the state Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and other agencies as necessary
  • Assists with the maintenance of a Knox-Keene License and all necessary modifications and amendments to that license
  • Assists in the development and maintenance of policies and procedures consistent with regulatory and state contract requirements and current industry standards
  • Assists in the implementation of audit processes to ensure compliance with federal and state statutes and regulations and program guidance
    • Assists in the development, implementation and maintenance of the compliance audit program and risk assessment
    • Conduct enterprise-wide audit to evaluate Plan’s compliance with state and federal laws, regulations and policies
    • Prepare written reports of audit results, including recommendations for improvement and compliance with state and federal laws and regulations
    • Communicate to key stakeholders regarding audit findings and corrective actions, if necessary
  • Other related projects and duties as may be required

Primary external contacts include State Department of Managed Health Care, State Department of Health Care Services, other County Organized Health Systems and Medi-Cal plans and industry organizations such as the California Alliance of Health Plans and the Association of Health Insurance Plans.

Qualifications

Skills

Required Word: Intermediate
Excel: Intermediate
Microsoft Office: Intermediate

Behaviors

Required

Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Experience

Required

Experience working with regulatory agencies desirable; basic knowledge of Medi-Cal and Knox-Keene requirements preferred
Internal Audit Standards experience
1 year: Healthcare field experience - preferably in a managed care setting

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