Compliance Delegation Specialist II

Compliance Delegation Specialist II - 25-227 page is loaded## Compliance Delegation Specialist II - 25-227locations:
San Ramon, California time type:
Full time posted on:
Posted Todayjob requisition :
R2335
** We’re delighted you’re considering joining us!
** At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.
** Join Our Team!
** Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.
** DE&I Statement:
** At Pri Med, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!
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* Job Description:

** The Compliance Delegation Specialist II is a member of the Compliance Department. Under the direction of the Manager of Compliance Delegation and in support of the Compliance Officer, this position will assist in the coordination and implementation of Compliance Delegation Program responsibilities and delegated oversight activities with contracted health plans, entities, and vendors. Assist in monitoring business activities for compliance when regulations change, support departments, and company strategies to ensure compliance with federal, state, and contractual healthcare requirements.

Assist in delegation audit preparation and developing reports/tools to monitor and track the implementation and completion of corrective measures. Supports the compliance team on general standards of conduct, FDR, FWA, OIG, HIPAA related matters. Knowledge of Medicaid/Medi-Cal, Medicare, and Medi/Medi regulations applicable to health plans and IPA’s required.

Additionally, the Compliance Delegation Specialist II is responsible for establishing and maintaining collaborative, courteous, and professional relationships with health plan representatives as well as interdepartmentally within Pri Med/Hill Physicians. Cooperates with management, collaborates with cross-functional teams, and performs other duties as assigned. The responsibilities below will be carried out and managed under the guidance and supervision of the Manager of Compliance Delegation.
** ESSENTIAL  RESPONSIBILITIES:
**** Administrative:
*** Proficient in Microsoft products (Outlook, Word, Excel, and PowerPoint) and Adobe.
* Utilizes and Maintains SAI
360 Audit Management – External Audit Module and make recommendations to Compliance Delegation Manager and Compliance Officer as needed.
* Conduct and quality check monthly delegation reports timely and accurately.
* Ensure that Compliance Teams, Supervisors, and the Manager of Compliance Delegation are consistently kept informed and updated timely.
* Availability before and after business hours to support compliance department functions, and business needs.
* Attend calls, meetings, and other education sessions, as well as research and keep up to date on Health Plan requirements as they relate to Pri Med/Hill Physicians.
* Receive, track, coordinate and monitor health plan and third-party emails for delegation audit process, requests for information, and correspondence between Health Plans, third parties, and Pri Med.
* Assist with other functions as needed.
** Delegation Audits:
*** Conduct research for assigned tasks and inquiries for delegation audits related to utilization management, claims, credentials, and other audit areas as assigned to support business needs.
* Prepare delegation audit tasks, including assessing that the request meets the delegation audit…