Regulatory Compliance Specialist

Imperial Health Plan of California, Inc. provided pay range

This range is provided by Imperial Health Plan of California, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$72,000.00/yr - $77,000.00/yr

JOB SUMMARY: Support the Compliance Department for Imperial Health Plan of California, Inc. / Imperial Health Holdings Medical Group. May support the NCQA Accreditation Program and oversight processes, CMS compliance, Medicare Part D & C audits and accreditation best practices and ongoing training activities.

• Serve as the UM Compliance Specialist with Delegated Health Plan contacts for reporting deliverables. Track due dates and deliverables.
• Assist UM Lead Compliance Specialist with development of policies and procedures, program plans, and work plans for IHP/IHHMG.
• Assist in the organization of internal and external audits, compile requested documents for UM IHP/IHHMG regulatory audits, manage audit repositories and maintain master audit dashboard. Track due dates and deliverables.
• Schedule meetings for UM projects and/or regulatory audits.
• Assist in developing presentations/reports for UM.
• Acts as a resource to staff, providers and/or members for UM program information.
• Adheres to payroll policies and properly uses a timekeeping system with minimal manual changes.
• Maintains regular and consistent attendance.
• Adheres to Compliance Plan and HIPAA regulations.
• Other duties as assigned to support regulatory compliance.

Takes on special projects as needed and requested.

Performs other duties as assigned.

Attends staff meetings as required.

Attends appropriate training, seminars and workshops as required.

Customer Focus: Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct.

Fosters appropriate communication and relations with Supervisor, co-workers, and other staff.

Quality/Process Improvement/Safety

Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

Supports and demonstrates safety throughout all duties performed.

Follows established policies and procedures and understands and complies with all regulators’ standards set forth by governing entities.

• Regulatory compliance
• CMS
• NCQA
• Claims

High school graduate or equivalent.

Bachelor’s Degree or equivalent combination of education and technical experience can substitute in lieu of degree.

Associate

Full-time

Analyst, Project Management, and Quality Assurance

Hospitals and Health Care