Healthcare Administration Compliance ManagerDOCS Management Services • Coos Bay, Oregon, USA
Healthcare Administration Compliance Manager
DOCS Management Services • Coos Bay, Oregon, USA
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job_description.job_card.job_descriptionRead mark learn and inwardly digest federal state and contractual requirements related to Medicaid Managed Care Oversee a distributive compliance program in which each department within the organization shares responsibility for assigned compliance functions Provide technical assistance to internal departments providers and subcontractors as requested Develop implement and oversee annual audit plan for compliance with federal state and contractual requirements Identify and report areas of risk and vulnerabilities and develop responsive procedures disciplinary guidelines and corrective action for external monitoring and reviews Develop corrective action plans for findings resulting from contractor reviews Assist in the development of corrective action plans for EQR reports that result in findings Monitor corrective action plans until findings are fully resolved Develop compliance program activities including in-service training programs for board members staff members contractors and providers with particular emphases given to : (1) Fraud Waste and Abuse; (2) Program Integrity; (3) Certifications and Conflict of Interest; (4) Provider Selection and Exclusion; (5) Enrollee Rights and Protections; and (6) the Patient Grievance System; (7) Human Resources; (8) HIPAA Privacy & Security; and (9) Contracts Oversee monitoring auditing and investigation to review significant findings or trends through internal and external processes for the purposes of identifying and responding to potential risk or areas of non-compliance and engaging in corrective and preventative action Review and enforce compliance policies and procedures to address areas of risk and to promote internal regulatory and contractual compliance Participate in the review of complaints and reports of alleged non-compliance Periodically analyze the resources assigned to compliance functions to ensure that such resources are adequate for maintaining an effective compliance program Report on a regular basis to the compliance committee on matters involving the compliance program Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies and / or officials as appropriate or required Participate in quality and organizational process improvement activities and teams when requested Ensure compliance with company policies and procedures as applicable to area(s) of responsibility Handle confidential information and materials appropriately and maintain a secure work area Other duties as assigned Participate in quality and organizational process improvement activities when requested Support and contribute to effective safety quality and risk management efforts by adhering to established policies and procedures maintaining a safe environment promoting accident prevention and identifying and reporting potential liabilities Openly clearly and respectfully share and receive information opinions concerns and feedback in a supportive manner Work collaboratively by mentoring new and existing co-workers building bridges and creating rapport with team members across the organization Provide excellent customer service to all internal and external customers which includes team members members students visitors and vendors by consistently exceeding the customers expectations Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications Advance personal knowledge base by pursuing continuing education to enhance professional competence Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards Represent organization at meetings and conferences as applicable Plan orient and assign work to personnel that supports goals and objectives contained in the organizations Strategic Plan and delivers outstanding team-based services Promote a culture of risk-management team-based values-based high-performance and continually improving practice that values learning and a commitment to quality Establish and monitor assigned staff performance assign accountabilities set objectives and establish priorities Ensure the completion of annual Development Reviews for assigned staff and recommend merit wage adjustments as appropriate per policy Assist in the recruitment hiring orientation development and evaluation of assigned staff to ensure Promote employee retention productivity and satisfaction through ongoing support encouragement empowerment coaching and effective teamwork Ensure staff comply with approved organizational policy and procedure Knowledge of federal and state employment and labor laws Assist employees to read interpret and apply policies and procedures Support and mobilize assigned staff to engage in their assigned work through implementation of team building performance coaching and problem-solving strategies Ensure that staff is cross-trained to accomplish the goals and objectives of the organization Responsible to back-up assigned staff workloads when necessary Respond to the needs of direct and indirect staff with clear open and honest communication mutual respect and consistent follow through to generate trust and enhance personal effectiveness Recommend discharge of employees when indicated based on work performance and behaviors Demonstrated teaching ability and experience Adept knowledge of federal and state regulations as related to Coordinated Care Organizations (CCO) Thorough knowledge of research and investigation practices Knowledge of Oregon Health Authoritys CCO contract for Advanced Health Stay up-to-date on actual proposed or pending legislation and regulations that affect operations and identify operational obstacles to compliance Capable of independent work while at the same time open to accepting supervision and working effectively as the member of a team Strong analytical and assessment skills Strong interpersonal and professional communication skills both orally and in writing Clean concise writing and presentation skills Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems Skill in change management conflict resolution interpersonal relationship quality management systems thinking teamwork leadership facilitation and project management Ability to conduct and implement ethical work practices Ability to interview investigate and enforce regulations firmly tactfully and impartially Ability to work independently as well as with all levels of staff members and external partners and vendors Ability to handle a high-volume workload and effectively prioritize work to meet changing deadlines Ability to take initiative anticipate next steps and be proactive Ability to be flexible in a fast-paced environment and adaptable to change Demonstrated professionalism and capacity to navigate a complex structure and respond to shifting and fluid priorities Ability to report to work as scheduled and willingness to work a flexible schedule when needed Proficient in Microsoft Office Suite and Windows Operating System (OS) Training in or awareness of Health Literacy Poverty Informed Systemic Oppression language access and the use of healthcare interpreters uses of data to drive health equity Cultural Awareness Trauma-Informed Care Adverse Childhood Experiences (ACEs) Culturally and Linguistically Appropriate Service (CLAS) Standards and universal access Knowledge and understanding of how the positions responsibilities contribute to the department and company goals and mission Knowledge of federal and state laws including OSHA HIPAA Waste Fraud and Abuse Awareness and understanding of equity diversity inclusion and the equity lens : ability to analyze the unfair benefits and / or burdens within a society or population by understanding the social political and environmental contexts of policies programs and practices Excellent people skills and friendly demeanor Critical thinking skills of using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems Attention to detail and organization skills
We are currently hiring a REMOTE Compliance Manager! If you are experienced in healthcare compliance and auditing have a strong attention to detail and value being part of a team that makes a difference you may be the right person for the position! Apply today!
JOB SPECIFICATIONS
Classification : EXEMPT Status & Schedule : FULL-TIME MONDAY FRIDAY 8AM 5PM
Location : REMOTE LOCAL TO OREGON STRONGLY PREFERRED
Work Location : OR CA AZ TX FL
Salary : $3076.95 - $3653.85 / bi-weekly
Department : COMPLIANCE Reports to : CHIEF QUALITY & COMPLIANCE OFFICER Supervision Exercised : OVERSIGHT OF COMPLIANCE STAFF
Job Purpose : Compliance Manager
The Compliance Officer is responsible for a wide range of tasks to ensure DOCS and SWOIPA are in compliance with any and all relevant regulations and standards related to Medicaid Managed Care. The position is responsible for Compliance program implementation oversight and management.
Qualifications Education & Experience
- Bachelors degree or equivalent in healthcare administration business or other related field of study required Masters level strongly preferred
- Five years of relevant experience in law ethics organizational business or healthcare required. Healthcare auditing experience preferred
- Current Healthcare Compliance Association or willing to work towards obtaining certification
- Current Certified Professional Coder or willing to work towards obtaining certification
- Must maintain ongoing core and specialized professional healthcare compliance and FWA knowledge training and education
Essential Responsibilities : Compliance and Auditing
Essential Responsibilities : ORGANIZATIONAL TEAM MEMBER
Essential Responsibilities : Personnel Management
Knowledge Skills & Abilities :
Working Conditions :
This position must have the ability to remain in a stationary position occasionally move about inside the office to access office machinery printer etc. frequently communicate and exchange accurate information.
Work Condition : Remote
Employee generally works within a remote work from home environment.
Travel may be required on occasion.
Hours of operations and specific staff scheduling may vary based on operational need.
Exposed to :
Employee is responsible for maintaining a safe work environment that is conducive to successful productivity and work output.
Machines equipment tools and supplies used : Constantly operates a computer or other office productivity machinery or software such as fax copier calculator multi-line telephone system or scanner.
May answer a high volume of telephone calls complete documentation and use computer programs to either obtain or record information.
Multiple Duties : Must be able to work under conditions of frequent interruption and be able to stay on task.
Other Information :
This job description is intended to provide only basic guidelines for meeting job requirements. This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of DOCS Management Services employees. Other duties responsibilities and activities may change or be assigned at any time with or without notice.
Required Experience :
Manager
Key Skills
Revenue Cycle Management,HIPAA,Healthcare Management,PMBOK,Microsoft Outlook,Project Leadership,Data Management,Project Management,Affiliate Marketing,Project Management Software,Supervising Experience,Workday
Employment Type : Full Time
Experience : years
Vacancy : 1
Monthly Salary Salary : 3076 - 3653
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Manager Administration • Coos Bay, Oregon, USA
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