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Astrana Health · 1 day ago

Compliance Specialist

California, CA

Full-time

Hybrid

Mid Level

$75K/yr - $84K/yr

3+ years exp

Astrana Health is seeking a highly motivated Compliance Specialist to support their compliance efforts in the healthcare industry. The role involves researching and interpreting complex policies, managing health plan audits, and developing compliance training materials while ensuring adherence to regulatory standards.

Health CareMedical

Growth Opportunities

Responsibilities

Research and interpret complex policies regarding government programs requirements and maintain tracking of all delegation oversight activities from contracted delegated health plans, entities and vendors

Coordinate strategic communications and audits with delegated entities and internal business departments

Manage assigned health plan audits. Independently execute special assignments with general supervision. Monitor oversight and assist in ensuring compliance to regulatory standards and health plan contracts. Apply critical thinking and problem-solving skills to all actions

Track and trend areas of compliance and regulatory vulnerability and risk within the organization and assist in developing solutions to enhance processes. Assist Compliance Leadership in developing and coordinating compliance training materials for the company

Coordinates the preparation and completion of compliance program materials, documents, presentations, and department activities with a focus on auditing and monitoring processes

Analyze and interpret health plan audits instructions, requests and results, and distribute to operational departments. Use critical judgment to work on developing improvement plans as it pertains to Medicare, Medicaid, Commercial, and Duals program corrective actions

Assist in tracking audit submissions and maintaining internal documentation for consistency. Work collaboratively with all departments to follow up on audit items and ensure accuracy of information provided and timely submission, as needed

Works on ad hoc projects, routine assignments, and recurring tasks under the direction of Compliance leadership. Assist Compliance Leadership in documenting and analyzing changes across departmental policies when modifications are required due to audit findings and/or regulatory changes. Communicate required changes with business leads and ensure timely compliance with changes

Assist with drafting new policies and updating existing policies as required to ensure regulatory compliance, identifying areas of risk and recommending improvements

Assist in the design and execution of internal audits to assess the effectiveness of compliance controls and operational processes

Helps to identify complex problems and review related information to evaluate options and implement solutions

Ensure data accuracy and integrity through periodic audits and continuous monitoring

Assists in compiling data, analyzing, and producing quarterly and monthly reports

Supports maintenance of peripheral databases that support Corporate Compliance reporting needs

Performs periodic audits to ensure the accuracy and integrity of the data

Manage time efficiently to meet expected deadlines and maintain productivity in compliance and audit activities

Qualification

Compliance auditingMedicaid regulationsMedicare regulationsData analysisMS Office proficiencyProject managementCommunication skillsProblem-solvingAttention to detailInterpersonal skillsStrategic thinking

Required

3+ years of related experience in managed care or compliance, with a strong focus on auditing and monitoring, preferably within IPA and healthcare industry

Experience with interpreting and applying complex Medicaid and Medicare regulations and policies in healthcare administration setting

Excellent oral and written communication skills, with the ability to articulate audit findings and compliance recommendations clearly

Ability to understand and present information effectively and respond accurately to questions from business departments, outside agencies and vendors, and management

Strong reasoning, problem-solving, project management, attention to detail and organization skills

Ability to multi-task and prioritize work matters

Ability to work with and maintain confidential information

Strong interpersonal skills

Strategic thinking skills to provide practical advice with an awareness of legal risks in the business context

Intermediate proficiency in MS Word, PowerPoint, Outlook, and Excel, with a capability to utilize these tools for auditing and compliance reporting