Job Description

Job Description

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

What you Will be Doing:

Under general supervision responsible for coordination, assessment, research, analysis, maintenance and auditing of key compliance matters.

• Supports the development and renewal of state contracts and contract amendments, including coordination, verification, writing revisions of the EOC and submitting to the state.
• Conducts or assists in conducting risk assessments of HPSJ’s business practices and determining areas of exposure; recommends mitigation plans as needed.
• Conducts research and analysis on contractual and regulatory requirements with respect to HPSJ and delegated vendors.
• Maintains the compliance audit program, including schedules, standards, processes, reports and tools in close collaboration with the Compliance management.
• Conducts and coordinates routine and ad-hoc internal and external audits and identifies gaps that require corrective action plans.
• Coordinates or manages implementation of internal and external corrective action plans, monitoring progress and completion, coordinating interviews and document gathering; escalates as required.
• Provides guidance to internal and external stakeholders to ensure understanding and compliance with regulatory, contractual and accrediting requirements, and organization policies and procedures.
• Leads the compilation and tracking of deliverables; reviews deliverables for accuracy and facilitates corrections; obtains appropriate approvals and submits deliverables according to timelines.
• Analyzes and investigates suspected FWA and Privacy incidents for root cause, trends and tracks data to translate findings and develop processes for improvement or investigation.
• Evaluates financial impact of identified compliance issues, and reports findings.
• Develops and maintains routine and ad hoc Compliance Reporting, including but not limited to detailed and summary level reporting via written interpretation of analytical results to present to internal and external stakeholders.
• Enters and maintains data, information, documents and files according to standards, including but not limited to compliance software.

What You Bring

Knowledge, Skills, Abilities and Competencies

Required:

• In-depth knowledge of federal and state regulations and standards, including False Claims Act, Medi-Cal and DMHC/DHCS as they relate to compliance in health care.
• In-depth knowledge of managed care health plan functions and interactions as they relate to compliance.
• In-depth knowledge of contracting regulations and best practices.
• Basic knowledge of ICD-10 and CPT coding and medical terminology, and industry standard payment practices.
• In depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
• Strong analytical skills, including the ability to perform routine analysis, using identified data, information and/or issues, and provide recommendations.
• Produces work that is accurate and complete.
• Produces the appropriate amount of work.
• Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
• Rebounds from setbacks and adversity when facing difficult situations.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• In-depth knowledge of basic data analysis tools and techniques, with ability to analyze and interpret data.
• Strong problem solving skills, with the ability to identify and resolve problems of moderate complexity.
• Strong research skills with the ability to identify and review complex materials to develop and evaluate options and propose solutions.
• Strong organizational and project management skills, with the ability to prioritize and complete a variety of tasks, and prioritize work of others.
• Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of HPSJ; the ability to effectively explain complex information and document according to standards.
• Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
• Time management: Uses time effectively and efficiently; values time; concentrates his/her efforts on the more important priorities; can attend to a broader range of activities; meets deadlines.
• Strong leadership skills, with the ability to influence without authority, establish direction, build alliances and motivate others.
• Commitment to and ability to facilitate the adoption of HPSJ’s strategy, vision, mission and values.
• Strong mathematics skills, including the ability to calculate ratios, perform simple algebra and statistical formulas.
• Intermediate skills in Word, Excel, Power Point, Visio and Project.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion

Preferred

• Basic skills in reporting software, such as Tableau, with ability to present data in consumable formats such as charts and graphs.

What You Have:

Education & Experience

Required

• Bachelor’s Degree; and
• At least three years of experience reading, analyzing and interpreting State and Federal laws, rules and regulations; or
• Equivalent combination of education and experience

Preferred

• Experience as a Compliance Data Analyst in a Medi-Cal managed care plan

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision (90% paid medical for employees and 100% paid dental/vision for employees) with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics, or is associated with anyone who has or is perceived to have these characteristics.