We are currently hiring a REMOTE Compliance Manager! If you are experienced in healthcare compliance and auditing, have a strong attention to detail, and value being part of a team that makes a difference, you may be the right person for the position! Apply today! JOB SPECIFICATIONS Classification: EXEMPT | Status & Schedule: FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED Work Location: OR, CA, AZ, TX, FL Salary: $3,076.95 - $3,653.85/bi-weekly Department: COMPLIANCE | Reports to: CHIEF QUALITY & COMPLIANCE OFFICER | Supervision Exercised: OVERSIGHT OF COMPLIANCE STAFF Job Purpose: Compliance Manager The Compliance Officer is responsible for a wide range of tasks to ensure DOCS and SWOIPA are in compliance with any, and all, relevant regulations and standards related to Medicaid Managed Care. The position is responsible for Compliance program implementation, oversight and management. Qualifications, Education, & Experience • Bachelor’s degree or equivalent in healthcare administration, business, or other related field of study required, Master’s level strongly preferred • Five years of relevant experience in law, ethics, organizational business, or healthcare required. Healthcare auditing experience preferred • Current Healthcare Compliance Association or willing to work towards obtaining certification • Current Certified Professional Coder or willing to work towards obtaining certification • Must maintain ongoing core and specialized professional healthcare compliance and FWA knowledge, training, and education Essential Responsibilities: Compliance and Auditing • Read, mark, learn, and inwardly digest federal, state, and contractual requirements related to Medicaid Managed Care • Oversee 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 audit plan 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 contractor 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 • 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 • Participate in quality and organizational process improvement activities and teams when requested • Ensure compliance with company policies and procedures as applicable to area(s) of responsibility • Handle confidential information and materials appropriately and maintain a secure work area • Other duties as assigned Essential Responsibilities: ORGANIZATIONAL TEAM MEMBER • Participate in quality and organizational process improvement activities when requested • Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities • Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner • Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization • Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations • Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications • Advance personal knowledge base by pursuing continuing education to enhance professional competence • Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards • Represent organization at meetings and conferences as applicable Essential Responsibilities: Personnel Management • Plan, orient and assign work to personnel that supports goals and objectives contained in the organization’s Strategic Plan and delivers outstanding team-based services • Promote a culture of risk-management, team-based, values-based, high-performance, and continually improving practice that values learning and a commitment to quality • Establish and monitor assigned staff performance, assign accountabilities, set objectives, and establish priorities • Ensure the completion of annual Development Reviews for assigned staff and recommend merit wage adjustments as appropriate, per policy • Assist in the recruitment, hiring, orientation, development, and evaluation of assigned staff to ensure • Promote employee retention, productivity, and satisfaction through ongoing support, encouragement, empowerment, coaching and effective teamwork • Ensure staff comply with approved organizational policy and procedure • Knowledge of federal and state employment and labor laws • Assist employees to read, interpret and apply policies and procedures • Support and mobilize assigned staff to engage in their assigned work through implementation of team building, performance coaching and problem-solving strategies • Ensure that staff is cross-trained to accomplish the goals and objectives of the organization • Responsible to back-up assigned staff workloads when necessary • Respond to the needs of direct and indirect staff with clear, open, and honest communication, mutual respect, and consistent follow through to generate trust and enhance personal effectiveness • Recommend discharge of employees, when indicated, based on work performance and behaviors • Demonstrated teaching ability and experience Knowledge, Skills, & 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 • 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 • Strong interpersonal and professional communication skills, both orally and in writing • 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 take initiative, anticipate next steps, and be proactive • 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 • Ability to report to work as scheduled, and willingness to work a flexible schedule when needed • Proficient in arenaflex Office Suite and Windows Operating System (OS) • 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 • 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, diversity, inclusion, and the equity lens: ability to analyze the unfair benefits and/or burdens within a society or population by understanding the social, political, and environmental contexts of policies, programs, and practices • Excellent people skills and friendly demeanor • Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems • Attention to detail and organization skills 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: Remote Employee generally works within a remote work from home environment. Travel may be required on occasion. Hours of operations and specific staff scheduling may vary based on operational need. Exposed to: Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output. Machines, equipment, tools, and supplies used: Constantly operates a computer or other office productivity machinery or software, such as fax, copier, calculator, multi-line telephone system, or 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 task. Other Information: This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of DOCS Management Services employees. Other duties, responsibilities and activities may change or be assigned at any time with or without notice. Apply tot his job Apply tot his job