Regulatory and Reporting Specialist

Looking for a way to make an impact and help people? Join Pacific Source and help our members access quality, affordable care!

Pacific Source is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. Pacific Source values the diversity of our community, including those we hire and serve.

We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

• In partnership with Compliance staff and leadership, develop auditing and monitoring plans to assess compliance with all State, Federal, and internal business rules and regulations.
• Serve as an inter‑departmental liaison for compliance and FWA activities.
• Inform all business operations and workflow decisions to ensure that programs are compliant with State, Federal, and internal business rules and regulations.
• Be fully informed and ensure compliant processes are in place on all business operations, including but not limited to: business processes, OIG status, FWA programs, Helpdesk operations including call monitoring, communication strategies, website publications, claims adjudication, and all vendor‑managed programs.
• Maintain a current working knowledge of all applicable Medicare and Medicaid rules and regulations, including assessment, impact reports, and training on any new rules or regulations to all impacted departments.
• Conduct frequent monitoring activities of all business operations, publish results and report out to Leadership, Compliance Department, quality committees, and other Pacific Source leadership teams as applicable.
• Respond to all compliance‑related inquiries from internal Compliance Department staff and external Auditors in a timely, professional, and accurate manner to ensure minimal organizational and operational impact.
• Work collaboratively with leadership to produce and monitor department policies and procedures as applicable and ensure their regular maintenance to reflect new practices and guidance.
• Provide interpretation, training, and implementation of Medicare and Medicaid regulations and communicate them appropriately with respective departments and teams.
• Attend weekly meetings; review and approve external communications; and monitor operational performance reports.
• Support ongoing communication efforts.
• Maintain compliance for members, departments, and provider communications.
• Keep letters and other member communications up to date with compliance guidance and best practices.
• Support responsibilities:
  Meet department and company performance and attendance expectations; follow the privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information; perform other duties as assigned.

• Minimum of 2 years of compliance‑related experience required; strong preference for health insurance experience.
• High school diploma or equivalent required;
  Bachelor’s degree preferred.
• Strong computer skills, excellent verbal and business writing skills, excellent public relations skills, good understanding of medical terminology.
• Ability to define and prioritize problems and manage workload without direct supervision.
• Competencies:
  
  adaptability, building customer loyalty, building strategic work relationships, building trust, continuous improvement, contributing to team success, planning and organizing work.
• Work inside a general office setting with ergonomically configured equipment; travel required approximately 10% of the time.
• Skills:
  
  accountability, collaboration, communication (written/verbal), flexibility, listening (active), organizational skills/planing and organization, problem solving, teamwork.

Base Range: $44,982.98 – $71,972.77. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity.