Job Description

Montage Health’s application process has changed effective 12/20/2019.
If you submitted an online application prior to 12/20/2019, you will be required to recreate your profile information if you want to apply to any new positions. You will no longer have access to your previously saved profiles and applications. Current employees applying for transfer into a posted position must also create a profile.

  • Excellent Pay and Generous Benefits including a Pension and Continuing Education Reimbursement
  • Excellent Team Orientated Culture
  • Free Gym for Employees

Job Description:

Under the leadership of the Compliance Officer, the Compliance Manager is responsible for assisting in the implementation and ongoing management of the Aspire Health Plan (AHP) compliance program.  The Compliance Manager - working in partnership with the Compliance Officer, first tier, downstream and related entities (FDRs) and operational departments - will assist with all facets of the compliance program. The Compliance Manager will have particular responsibility for the Compliance Department’s investigative, auditing and monitoring functions. This position works to ensure that AHP operates within the policies, procedures, and regulations set forth by AHP, by the Centers for Medicare and Medicaid (CMS), the California Department of Managed Health Care (DMHC) and the Department of Labor, by state and federal laws, including HIPAA and Fraud/Waste and Abuse statutes and regulations.

Responsibilities

  • Manage the Compliance Department’s Annual Auditing & Monitoring Work Plan;

  • Conduct investigations of potential compliance concerns (including allegations of FWA);

  • Plan, conduct, and coordinate internal audits (i.e., ad hoc, focused, risk-based and annual);

  • Oversee the capture and analysis of key performance indictors;

  • Develop and oversee implementation of corrective action plans;

  • Support the Operations Department with annual reporting, timeliness monitoring projects and Program Audits (as needed);

  • Remain current on all regulatory requirements with all applicable state and federal rules, regulations, and laws, including CMS, PHS, IRS, HIPAA, ERISA, COBRA, ACA, and the Knox-Keene Act;

  • Monitor industry best practices and make recommendations for organizational policy and procedure change that will result in compliance; 

  • Interact effectively with various internal and external departments to provide assistance and information;

  • Efficiently and effectively document information and activities so they can be tracked, trended and utilized for compliance verification and process improvement;

  • Promote the satisfaction, development and productivity of the Compliance Team; 

  • Participate as part of, and in support of, a management team that works collaboratively to ensure the success of Aspire Health Plan’s goals, objectives, and strategic initiatives;

  • Perform other duties as assigned.

Competencies

  • Attention to Detail: Achieves thoroughness and accuracy when accomplishing tasks, asking probing questions and conducting investigations.

  • Accountability and Dependability: Assumes responsibility for accomplishing duties in an effective and timely manner.

  • Integrity:  Consistently honors commitments and takes responsibility for actions and words.  

  • Software and Computer Skills: Proficient in the use of Microsoft Office Suite, Highly skilled at using the Internet. Must learn effectively with computer-based and/or online training.

  • Flexibility:  Demonstrates adaptability and openness to alternative solutions and flexibility when interacting with others, understanding their attitudes, needs, interests, and perspectives.

  • Inclusiveness:  The ability to network and partner with all internal and external stakeholders including broad and diverse representation of private/public and traditional/non-traditional community organizations.

Position Requirements

  • Bachelor’s degree in related field or other relevant professional experience

  • 3-5 years’ of compliance or policy experience within the health care or health insurance industry

  • Working knowledge of Medicare and/or Medicare Advantage regulations, resources and processes

  • Experience designing, conducting and monitoring compliance audits

  • Knowledge of health plan operations and issues

  • Strong knowledge of compliance principles, practices, and procedures

  • Strong leadership and management skills

  • Excellent organizational and interpersonal skills

  • Excellent business acumen and writing skills

  • Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances

  • Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity

  • Ability to use sound judgement, identify next steps to be taken, and develop appropriate solutions.

  • Ability to collaborate with multiple parties to solve problems

  • Occasional travel required

Preferences

  • Juris Doctor (JD) from an accredited ABA law school

  • Certification in Healthcare Compliance (CHC)

Assigned Work Hours:

Full time, Exempt

Position Type:

Regular

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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