Compliance Specialist

AllCare Health Headquarters, Grants Pass, OR, US 7 days ago Requisition ID: 1224 Salary Range: $26.00 To $30.00 Hourly Compliance Specialist AllCare Health | Compliance Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Compliance Specialist is responsible for assisting in the oversight of an enterprise-wide Corporate Compliance Program to detect, correct and prevent violations of Federal and State laws, rules, or regulations. The position is responsible for assisting the Chief Compliance Officer with implementing, maintaining and monitoring the compliance program elements that includes investigations, policies, standards, workforce training, and awareness of general compliance requirements, reporting, and investigating concerns of FWA. This position will help in the evaluation of the FWA and Compliance Program. The Compliance Specialist will report to the Chief Compliance Officer in the investigation of suspected violations and in the development and oversight of corrective action plans. The Compliance program involves a continuous process of adhering to legal, ethical and professional standards applicable to AllCare employees, Board of Governors, providers, contractors, temporary employees, consultants and subcontractors. The Compliance Specialist will cooperate and assist in submitting appropriate referrals and case documentation to enforcement agencies such as the Medicaid Fraud Unit (MFCU), Office of Program Integrity (OPI), Office of Inspector General (OIG), Department of Justice (DOJ), Centers for Medicaid and Medicare Services (CMS) and the Oregon Health Authority (OHA) for auditing, monitoring and oversight of external subcontractors (delegates). Investigate all suspected cases of FWA. Conducts investigations, utilizing data analytics, forensic tools and conduct thorough fact-finding inquiries. Write investigations reports to be submitted to OHA, MFCU and OPI. Maintain a comprehensive knowledge of applicable federal and state laws, regulations and other requirements. Assist in audits conducted by outside regulatory agencies. Assist in audits conducted by AllCare Health of its subcontractor (delegates) or First Tier Entities. Upholds the highest level of confidentiality in verbal, written or electronic communications pertaining to Compliance, FWA or HIPAA Privacy and Security referrals. Job Duties Investigations & Risk Management: Manage the investigative process for potential compliance violations, including fraud, abuse, conflicts of interest, and other regulatory breaches. Oversee the identification, reporting, and investigation of compliance concerns, and provide guidance on risk mitigation strategies. Utilize investigative techniques, data analytics, and forensic tools to identify suspicious activity and conduct thorough fact-finding inquiries. Prepare investigative reports with findings, conclusions, and recommendations for corrective actions. Regulatory Guidance & Reporting: Act as the organization’s subject matter expert on healthcare regulations, including but not limited to Stark Law, Anti-Kickback Statute, False Claims Act, and others. Maintain a comprehensive knowledge of applicable federal and state laws, regulations and other requirements. Assists in conducting the annual enterprise-wide risk assessment and program evaluations. Assist the Chief Compliance Officer in the development of risk-based compliance monitoring work plan and protocols. Actively participate in the Compliance program, FWA and HIPAA Privacy & Security activities. Accurately log and maintain records of reported or discovered compliance concerns. Provide guidance to internal staff on appropriate interpretation and application of internal and regulatory policy/procedures. Use sound logic and reasoning to identify opportunities to improve processes. Effectively communicate with peers and other departments on compliance matters, work collaboratively in a team environment with a spirit of cooperation. Maintains punctual, regular and predictable attendance. Respectfully takes directions from Chief Compliance Officer and Corporate Legal Counsel. Meets all required training including continuing education for certifications such as, but not limited to: CFE, CHC, AHFI, CPC, and those listed in Relias Learning Module System (LMS). Performs other duties as assigned. Maintains punctual, regular and predictable attendance. Works collaboratively in a team environment with a spirit of cooperation. Respectfully takes direction from leadership. Meets all required training including those listed in Relias Learning Module System (LMS). Performs other duties as assigned. On Call Responsibilities This position does not have any on call responsibilities. Supervisory Responsibilities This position does not have any supervisory responsibilities. Job Requirements May require the use of personal vehicle for local travel (subject to mileage reimbursement). May require the use of a personal cell phone (cell phone stipend applicable). Qualifications Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. Education Bachelor's degree (BA) from a four-year college or university in criminal justice, fraud management, or healthcare administration preferred. Experience One to two years related experience and/or training in criminal justice, fraud management, investigations, or healthcare administration. Knowledge of CPT Codes, ICD-10 Codes, Medicare Guidelines, OIG Work Plan priorities, Oregon Health Plan Contract Requirements, HIPAA, FWA and Compliance CFRs, Regulations and Statutes. Certificates, Licenses, and/or Registrations Valid Oregon Driver’s License and vehicle insurance. Technical Skills Familiarity with the Healthcare industry. Exceptional writing, editing, and proofreading skills. Excellent organization and time-management skills. Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel). Knowledge of and compliance with HIPAA regulations. Knowledge of project management and/or change management. Interpersonal Skills Demonstrate accountability, inspiring trust and confidence from others. Self-resolve most conflicts or misunderstandings with minimal need for direct supervision. Work with high initiative, energy and effectiveness in a fast-past environment. Effectively and professionally communicate with team members and customers. Collaborate within a multidisciplinary, diverse team to provide professional service. Prioritize and organize work according to competing timelines. Allocate your time so that you can complete tasks within established deadlines. Maintain an attentive and empathetic demeanor. Maintain a high degree of professionalism and confidentiality. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. Computer Skills Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e‑mail and use scheduling software. Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and work with several abstract and concrete variables. Physical Demands & Work Environment The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate. The employee must be able to work onsite for all scheduled shifts. The employee may be able to work from a home office occasionally, as needed with leader’s approval. The employee must be able to travel locally, as needed. Company Overview AllCare Health is an Oregon Benefit Corporation and has maintained Certified B Corporation® status since 2017. We consider our impact on our community, society, and the environment as part of our business decisions. AllCare Health headquarters are located in Grants Pass, Southern Oregon, along the Rogue River and surrounded by mountains, forests, small farms, and scenic outdoor recreation. The region offers access to rafting, fishing, hiking, biking, wineries, outdoor concerts, the Oregon Coast, redwood forests, and many other recreational and cultural opportunities. Purpose | Working together with our communities to improve the health and well-being of everyone. Values | Trust, Innovation, Relationships, and Voice. Vision | Thriving, Inclusive, and Equitable communities. Brand Promise | Changing Healthcare to Work for You. AllCare Health is dedicated to building a diverse and authentic workplace centered on belonging and serving our growing community. If you are excited about this position but your experience does not align perfectly with every qualification listed, we encourage you to apply. You may be the right candidate for this role or another opportunity with AllCare Health. If you need an accommodation, assistance with the application process, or this job announcement in an alternative format, please contact Human Resources at View phone number on click.appcast.io. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disability status, genetic information, or any other status protected by applicable law. Compliance Specialist AllCare Health | Compliance Department | Grants Pass, Oregon We Are Seeking Qualified Candidates to Join Our Team! AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options. Summary of the Position The Compliance Specialist is responsible for assisting in the oversight of an enterprise-wide Corporate Compliance Program to detect, correct and prevent violations of Federal and State laws, rules, or regulations. ... (same text as above) ... On Call Responsibilities This position does not have any on call responsibilities. Supervisory Responsibilities This position does not have any supervisory responsibilities. Job Requirements May require the use of personal vehicle for local travel (subject to mileage reimbursement). May require the use of a personal cell phone (cell phone stipend applicable). Qualifications Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others ... Education Bachelor's degree (BA) from a four-year college or university in criminal justice, fraud management, or healthcare administration preferred. Experience One to two years related experience and/or training in criminal justice, fraud management, investigations, or healthcare administration. Knowledge of CPT Codes, ICD-10 Codes, Medicare Guidelines, OIG Work Plan priorities, Oregon Health Plan Contract Requirements, HIPAA, FWA and Compliance CFRs, Regulations and Statutes. Certificates, Licenses, and/or Registrations Valid Oregon Driver’s License and vehicle insurance. Technical Skills Familiarity with the Healthcare industry. Exceptional writing, editing, and proofreading skills. Excellent organization and time-management skills. Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint and Excel). Knowledge of and compliance with HIPAA regulations. Knowledge of project management and/or change management. Interpersonal Skills Demonstrate accountability, inspiring trust and confidence from others. Self-resolve most conflicts or misunderstandings with minimal need for direct supervision. Work with high initiative, energy and effectiveness in a fast-past environment. Effectively and professionally communicate with team members and customers. Collaborate within a multidisciplinary, diverse team to provide professional service. Prioritize and organize work according to competing timelines. Allocate your time so that you can complete tasks within established deadlines. Maintain an attentive and empathetic demeanor. Maintain a high degree of professionalism and confidentiality. Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations ... Mathematical Skills Ability to work with mathematical concepts such as probability and statistical inference ... Computer Skills Job requires specialized computer skills. Must be adept at using various applications ... Reasoning Ability Ability to define problems, collect data, establish facts, and draw valid conclusions ... Physical Demands & Work Environment The physical demands described here are representative of those that must be met by an employee ... The employee must occasionally lift and/or move up to 10 pounds ... The employee must be able to work onsite for all scheduled shifts. The employee may be able to work from a home office occasionally, as needed with leader’s approval. The employee must be able to travel locally, as needed. Company Overview AllCare Health is an Oregon Benefit Corporation and has maintained Certified B Corporation® status since 2017. We consider our impact on our community, society, and the environment as part of our business decisions. AllCare Health headquarters are located in Grants Pass, Southern Oregon, along the Rogue River and surrounded by mountains, forests, small farms, and scenic outdoor recreation. ... Our Corporate Principles Purpose | Working together with our communities to improve the health and well-being of everyone. Values | Trust, Innovation, Relationships, and Voice. Vision | Thriving, Inclusive, and Equitable communities. Brand Promise | Changing Healthcare to Work for You. AllCare Health is dedicated to building a diverse and authentic workplace centered on belonging and serving our growing community ... If you need an accommodation, assistance with the application process, or this job announcement in an alternative format, please contact Human Resources at View phone number on click.appcast.io. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disability status, genetic information, or any other status protected by applicable law. Monday - Friday 8:00am - 5:00pm w/ a 1 hour unpaid lunch and two 15 minute paid breaks 40 hours per week #J-18808-Ljbffr AllCare Health