Compliance Specialist in Orange at Prospect Medical Systems

Date Posted: 8/2/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    8/2/2019
  • Job ID:
    12715

Job Description



Compliance Specialist - Audit & Oversight

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Under the direction of the Manager of Compliance & Government Programs, and in support of the VP of Compliance, this position will assist in the coordination and implementation of Compliance and Government Program delegated oversight activities with contracted entities and vendors.  



Job Responsibilities/Duties

  • Assists in monitoring of business activities for compliance when regulations changes, support departments and company strategies to ensure compliance with federal, state and contractual healthcare requirements.
  • Assists in audit preparation and the development of reports/tools to monitor and track implementation and completion of corrective measures.
  • Supports the compliance team on general standards of conduct, FDR, FWA, OIG, HIPAA related matters.
  • Researches and interpret complex policies regarding government programs requirements and maintain tracking of all delegation oversight activities with contracted delegated entities and vendors.
  • Analyzes and interpret health plan audits results and distribute to operational departments. 
  • Assists Manager with documenting and analyzing changes across departmental policies when modifications are required due to audit findings and/or regulatory changes.
  • Uses critical judgment to work on developing improvement plans as it pertains to Medicare, Medicaid and duals contracts corrective actions.


Qualifications

Minimum Education: High school diploma or equivalent required, Bachelor’s Degree preferred.

Minimum Experience: Minimum of three (3) years related experience in compliance, regulatory-government programs, preferably with direct experience dealing with interpreting and applying complex Medicaid and Medicare rules and policies in a healthcare administration setting.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Government Programs, Compliance Specialist, Auditor, Compliance



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