Career Opportunities: Sr Compliance Specialist (24653)

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

Job Summary

The Sr Compliance Specialist is responsible for supporting administration of compliance processes within CareOregon. Core work includes identifying effective measures to detect, correct and prevent compliance issues. This senior level role focuses on the more complex compliance issues related to government rules and regulations, as well as contractual agreements that may require in-depth research and evaluation. Additionally, this position ensures that appropriate procedures are in place and followed consistently to safeguard organizational assets, verify the accuracy and reliability of data, and promote efficient and effective operations.

Essential Responsibilities

• Monitor and maintain processes for receiving, documenting, tracking, investigating and acting on moderately challenging to complex reports concerning non-compliance concerns.
• 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 business.
• Provide recommendations for the Compliance Manager regarding improvements or corrective actions for operational areas where a deficiency may exist.
• Maintain and implement improvements to documentation systems for communicating, implementing, and administering new and existing regulatory requirements.
• Prepare, proofread, track and distribute a variety of reports, correspondence and forms with the care and discretion appropriate for protected health information (PHI) and confidential documents.
• Assist operational areas in developing complex contracts and procedures to ensure compliance with applicable rules, regulations and requirements.
• Educate and coach leaders and staff regarding compliance requirements including complex requirements and challenges.
• Design, create and lead implementation of the annual, company-wide compliance training program.
• Facilitate and coordinate medium to large-size, complex audit projects through the entire process from submission to corrective action and resolution.
• Facilitate and coordinate a variety of audits involving multiple individuals and teams (e.g., external auditors, internal stakeholders, government audits, on-site audits, etc.).
• Prepare and present reports of audit results to senior leadership.
• Serve as an internal resource and point of contact for compliance related questions and feedback.
• Develop and implement compliance policies and procedures.
• Maintain clear communication and effective relationships with government agencies.

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 monitoring and ensuring organizational compliance with industry standards and applicable laws 
• Certification in Healthcare Compliance (CHC) or similar designation (or acquired within 18 months of hire)

Preferred

• Compliance experience in health care or health insurance

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge of Medicare and Medicaid compliance practices and procedures
• Understanding of managed health care operations

Skills and Abilities

• Strong ability to research and interpret government requirements (e.g., Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules, HIPAA, Medicare Advantage Manuals, etc.)

• Effective computer skills (e.g., Microsoft Office, Word, Excel, Visio, etc.); ability to learn new skills
• Excellent interpersonal customer service skills
• Strong communication skills (including spoken, written, listening and presentation)
• Excellent analytical skills, observation skills and attention to detail
• Strong ability to operate with a high degree of professionalism and safeguard confidential information
• Strong ability to work independently and as part of a team in a fast-paced environment
• Strong ability to take the initiative, use good judgement and work under minimal supervision
• Ability to manage projects effectively
• 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

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.

Equipment:  General office equipment

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

Work Location: Work from home

#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.