Career Opportunities: Compliance Specialist (24592)

Job Summary

The Compliance Specialist is responsible for supporting the administration of compliance processes within CareOregon. Core work includes identifying effective measures to detect, correct and prevent compliance issues. This includes compliance issues related to federal and state rules and regulations, as well as contractual agreements. Additionally, this position helps ensure 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 simple to moderately complex reports concerning non-compliance concerns.
• Perform all aspects of less complex compliance reviews to evaluate compliance with federal and state laws and regulations as well as other contractual agreements for all lines of business.
• May assist or partner with the Sr Compliance Specialist on more complex or larger compliance reviews.
• Observe operational areas that may need improvement or require more immediate attention; share observations and ideas with the Compliance Manager.
• In partnership with the Sr Compliance Specialist, develop and maintain an organized system for documenting compliance records and activities (e.g., communications, administration, etc.)
• Assist in preparing, proofreading, tracking and distributing a variety of documents with the care and discretion appropriate for protected health information (PHI) and confidential information.
• Assist operational areas in developing contracts and procedures to ensure compliance with applicable rules, regulations and requirements.
• Educate and coach staff about compliance requirements and promote high standards.
• Participate in the implementation of the annual, company-wide compliance training program and the creation of effective educational tools.
• Facilitate and coordinate small to medium-size 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 reports of audit results for review by manager.
• Serve as an internal resource and point of contact for compliance related questions and feedback.

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 2 years’ experience monitoring, coordinating or supporting compliance processes

Preferred

• Compliance experience in health care or health insurance
• Designation as a Certified in Healthcare Compliance (CHC)

Knowledge, Skills and Abilities Required

Knowledge

• Growing knowledge of Medicare and Medicaid compliance practices and procedures
• Understanding of or ability to learn managed health care operations

Skills and Abilities

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

• Effective computer skills (e.g., Microsoft Office, Word, Excel, Visio, etc.); ability to learn new skills
• Good interpersonal customer service skills
• Good spoken and written communication skills
• Effective analytical skills
• Highly observant and detail-oriented
• Ability to operate with a high degree of professionalism and safeguard confidential information
• Ability to work independently and as part of a team in a fast-paced environment
• 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.