Career Opportunities: Sr Compliance Specialist (24613)

Candidates hired for remote positions must reside in Oregon or Washington.

Job Summary

This position ensures compliance with governmental requirements compliance program related functions for CareOregon, any subsidiary, or related entity. Core work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of several factors.

The Senior Compliance Specialists develops and implements compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed.

In this role, you will collaborate closely with various internal operational teams addressing compliance issues. You will assist with audits, tracking potential compliance issues, and review operational compliance program effectiveness monitoring activities. This role will have direct interaction with multiple operational areas, as a point of contact for regulatory questions and compliance feedback.

Essential Responsibilities

Position

• Maintain and recommend improvements to documentation system for communicating, implementing, and administering new and existing regulatory requirements.
• Monitor and maintain process for receiving, documenting, tracking, investigating, and acting on complaints concerning non-compliance concerns.
• Prepare, proofread, and distribute reports, correspondence, forms, and other information of a specialized and confidential nature.
• Coordinate multiple external government audits – annually for Medicaid and as need for Medicare – with internal stakeholders and external auditors through the entire process from submission to corrective action resolution, this includes on-site audits.
• Educate and coach staff regarding compliance requirements, including complex issues.
• Perform all aspects of compliance reviews at an advanced level to evaluate compliance with federal and state laws and regulations, as well as other contractual agreements for all lines of CareOregon’s business.
• Provide recommendations for the Compliance Manager regarding improvements or corrective actions for each operational area where it is determined that a deficiency may exist.

Department

• Propose and implement process improvements.
• Meet deadlines for completion of workload.
• Maintain agreed upon work schedule.
• Demonstrate cooperation and teamwork.
• Provide cross-training on specific job responsibilities.
• Meet identified business goals that contribute to departmental goals.
• Perform other duties as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years’ experience in performing compliance monitoring activities preferably in a health care setting.

Preferred

• Certification in Healthcare Compliance (CHC) or similar designation (or to be obtained within 18 months of hire).

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge and understanding of federal and state requirements, including Medicare and Medicaid Programs
• Managed health care operations
• Project management skills
• Strong analytical skills
• Effective computer skills, including MS Office Word, Excel, Visio and Outlook

Skills and Abilities

• Effective analytical skills

• Strong Interpersonal skills
• Strong written and verbal communication and documentation skills
• Effective computer skills, including MS Office Word, Excel, Visio, and Outlook
• Ability to work effectively with cross-functional teams and build strong relationships with stakeholders

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day
• Ability to operate and collaborate with a high degree of professionalism and confidentiality.
• Ability to work independently in a fast-paced environment; self-starter and reliable to complete work under minimal supervision.

Working Conditions

Work Environment(s):   ☒ Indoor/Office     ☐ Community       ☐ Facilities/Security      ☐ Outdoor Exposure

Member/Patient Facing:    ☐ No                        ☒ Telephonic        ☐ In Person    

         Hazards: May include, but not limited to, physical and ergonomic hazards. (Indoor/Office)

Equipment:  General office equipment

Travel: May include occasional required and optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. 

#LI-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.