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Location

San Ramon, CA | United States

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Job description

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Reporting directly to the Compliance Officer, assists in implementing a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business Operational Owners understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of monitoring, auditing, and investigations.

• Manage and coordinate with Operational Areas to ensure compliance with applicable state and federal regulations, and to fulfill all contractual requirements.
  
• Keep up to date on state and federal regulations, as well as contractual obligations, and evaluate potential impacts to business.
  
• Ensures compliance with regulatory (NCQA, DHCS, CMS, DMHC, etc.) requirements by partnering with operational departments and maintaining survey readiness, participating in audits.
  
• Manage internal compliance standards and execute proposed plans - manage compliance audits and assist with overall regulatory filings and approvals.
  
• External audit and payer compliance - manage compliance audits and overall regulatory filings and approvals.
  
• Manage relationships with external stakeholders on compliance and reporting issues.
  
• Analyze all departments for potential areas of exposure and make recommendations to management regarding how to mitigate risk and ensure ongoing compliance.
  
• Meet with Compliance Officer and management to report findings and obtain guidance on areas of focus and compliance initiatives.
  
• Monitor and update policies, guidelines, standards and procedures to support the Company's compliance with changes to governmental and contractual requirements.
  
• Coordinate with other internal departments to determine impacts of regulation and/or contractual updates on current processes and internal systems.
  
• Manage/Coordinate the plan to complete compliance training for the company annually.
  
• Manage record retention reviews and coordination.
  
• Monitor and control expenses throughout the year for the department's budget.
  
• Internal compliance monitoring - ensure HPCS and all employees are in compliance with state and federal regulatory standards, including established guidelines related to applicable insurance laws and regulations, and contractual obligations, accreditation standards, and ethical requirements related to the delivery of services.
  
• Responsible for oversight and management of HPCS Compliance Program for all compliance activities and serves as a resource on compliance issues. Provides direction and expertise to help facilitate compliance with applicable statutes and policies.
  
• Provides direction to HPCS Operational Directors on training and education of compliance requirements. Provides specialized compliance information for education and training when necessary.
  
• Enforces, as a representative of the Compliance Department, the Compliance Plan, Code of Conduct and Anti-Fraud Plan and Policies and Procedures.
  
• Establishes, at the direction of the Compliance Officer an active relationship with management and third parties who have specific experience in regulatory requirements and operations.
  
• Prepares written reports to inform the Compliance Officer, no less than monthly, the status of activities pertaining to overall HPCS compliance.
  
• Other duties as assigned.
  

Required Experience

• 5 years Health Plan Operations or Compliance Management and hands on experience.
  
• Knowledge of regulatory requirements (NCQA, DHCS, CMS, DMHC, etc.)
  
• Excel - VLOOKUPS, Pivot Tables. Power BI
  

Preferred Experience

• 10+ years Health Plan Operations or Compliance hands on experience.
  
• Experience with Governance Risk Compliance (GRC) systems.
  
• Compliance/ SAI360
  

Required Education

• Master's degree in healthcare, Business Administration or related.
  

Preferred Education

• Certified in HealthCare Compliance (HCCA - CHC) Must option within one year of hire.
  

Salary Range

$115,100.00 - $151,600.00

Additional Information

Hill Physicians is an Equal Opportunity Employer

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