Compliance Specialist, Healthcare

All Care Health Headquarters, Grants Pass, OR, US

2 days ago Requisition

Salary Range: $26.00 To $30.00 Hourly

All Care Health | Compliance Department | Grants Pass, Oregon

All Care 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 All Care 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 All Care 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…