Under the direction of the Compliance Manager, the Regulatory Compliance Specialist supports the compliance program by coordinating regulatory submissions internally such as filing of reports and submission of other information required by state agencies. This position is the primary liaison with the State agencies and internal departments to ensure submission deadlines are met and open issues are addressed to meet regulatory and contractual standards.
Principal responsibilities include:
· Coordinate and complete filings, reports, ad hoc requests, and other submissions to state, federal, and local agencies including but not limited to DMHC and DHCS.
· Contact with the State agencies and regulators for daily communication, reporting, and data requests
· Coordinate with internal departments to gather data and information for regulatory submissions
· Assist with the completion of DMHC amendments and material modifications to plan license including Evidences of Coverage (EOCs).
· Develop and maintain a calendar of reports and filings required by contract or regulations.
· Assist in receiving, digesting, and completing operational changes required resulting from the passage of new legislation, regulation, or regulatory guidance.
· Assist with internal information gathering as may be required during audits and other requests from state agencies.
· 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.
· 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.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s degree or equivalent experience required.
· Familiarity with Medicaid (Medi-Cal) and other publicly funded programs preferred.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Three years 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 work effectively as part of a team across organizational structure a must as well as the ability to work independently.
· Excellent organizational skills and orientation to detail.
· Proven ability to manage multiple projects simultaneously and meet deadlines.
· Experience in use of computer system software such as MS Word, Excel, Access, Outlook, SharePoint, and PowerPoint.
$58,760 - $88,150/annually