Compliance Specialist 2

This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position.

We have an opportunity to join the Alliance as a Compliance Specialist in the Compliance Department. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Compliance Manager, this position: 

• Conducts regular on-going review and analysis of relevant contractual provisions and state and federal statutes and regulations
• Researches questions from staff regarding regulatory compliance and responds to external requests for information, including related to Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare & Medicaid Services (CMS) requirements
• Assists with the implementation of internal and external audit processes to ensure compliance with federal and state statutes and regulations and provides related program guidance for all lines of business
• Coordinates Alliance delegate oversight activities to ensure subcontractors' compliance with state, federal, and Alliance requirements
• Performs other duties as assigned

ABOUT THE TEAM

The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization’s integrity and member access to quality healthcare. We are the team that helps employees understand and follow the complex rules and requirements to meet our important compliance obligations. In short, we define and support the Alliance's Culture of Compliance internally and with our external healthcare partners. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities.

THE IDEAL CANDIDATE 

• Has experience working in a managed care or healthcare environment 
• Has knowledge of the Medi-Cal and Medicare Advantage programs and related regulations
• Is experienced in audits and monitoring, risk assessment, and/or delegate oversight
• Has an acute attention to detail and data accuracy 
• Has experience working remotely and knows how to self-motivate while staying closely connected to their team  
• Has excellent multitasking skills and thrives in a fast-paced environment 
• Is efficient with their time and can meet strict deadlines

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here. 

• Knowledge of:
• The principles and practices of compliance programs and regulatory processes
• Quality improvement practices and related audit techniques
• Research, analysis, and reporting methods
• State and Federal legislative processes
• Ability to:
  • Quickly understand Alliance roles and responsibilities related to oversight agencies
  • Identify and research relevant legal materials, and analyze and interpret legal and contractual language
  • Learn and apply state and federal regulations related to compliance activities
  • Demonstrate strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
• Education and Experience:
  • Bachelor’s degree in Business or Public Administration, Public Policy, Health Care Planning, or a related field and a minimum of three years of compliance experience (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area