Description:
The Position.
The Regulatory & Compliance Manager will assist the Compliance Officer with implementation and ongoing development of the Company's Compliance Program to ensure adherence to regulatory requirements. The Regulatory & Compliance Manager will serve as a subject-matter expert on compliance and privacy related topics and will be responsible for working collaboratively with business units, external regulators, and clients to ensure compliance with applicable laws and regulations. This position will involve conducting, participating in, and preparing for audits, developing and conducting required training, writing and reviewing policies and procedures, reviewing contracts, conducting compliance investigations, and acting as a resource to business units and clients regarding compliance related inquiries. The Regulatory & Compliance Manager will develop and improve processes to monitor the quality and effectiveness of the Compliance Program and must demonstrate excellent written and verbal communication skills.
The Specs.
- Exempt.
- Full-Time.
- Hybrid.
- Monday - Friday
- Benefits - Eligible: PTO, PSL, Holidays, Floating Holidays, Medical, Dental, Vision, etc.
- Pay Range: Starting $85k and/or depending on experience.
We are an Equal Opportunity Employer and seek diversity in our workforce. We are also an E-Verify Employer, you can learn more about E-Verify program and your rights and responsibilities here: .
Main Duties.
- Support the Compliance Officer with the development and implementation of Company's Compliance Program and policies and procedures, which includes, but is not limited to, the following:
- Research and review federal and state regulations regarding compliance with Medi-Cal, Medicare, and other health care program requirements, update Company policies and procedures, and other documents, as necessary.
- Organize, prepare for, and participate in third-party auditing and monitoring activities including contracted health plan, federal, and state government audits (such as CMS and DMHC). Identify compliance issues that require follow-up or investigation.
- Assist with regulatory filings, including those required by CMS and/or DMHC.
- Review contracts between the health plan and physician groups, hospitals, providers, vendors, related entities.
- Develop, update, and conduct compliance, fraud/waste/abuse, HIPAA training modules for employees, clients, and subcontractors.
- Conduct investigations of actual and potential incidents of non-compliance, privacy, security, fraud, waste, and abuse violations by Company employees, vendors, and business associates.
- Conduct internal audits and monitoring activities of operational areas; log and track identified deficiencies; develop, issue, and monitor the implementation of corrective action plans.
- Communicate with and act as liaison for health plans, regulatory agencies, and other third parties; ensure that Company communication and responses are accurate and consistent.
- Assist with preparations for the Compliance Committee, including preparing agenda, meeting minutes, and other supporting documents.
- Provide support and guidance to the Compliance Officer, Compliance Committee, business operations, and clients, including researching and addressing compliance related inquiries from other business/operational areas.
- Support special projects and other tasks, as assigned.
Our Company.
Our team at IMS is looking for highly motivated and resourceful individuals to join our growing start-up. We strive to innovate the healthcare industry by providing management and consulting services to healthcare entities, including healthcare facilities, medical groups, providers, and suppliers. Using our wide-ranging experience and comprehensive knowledge of the healthcare industry, our team works to provide quality services and customer care to our clients and their Medicare beneficiaries. By working at IMS, you'll gain an in-depth perspective of the managed care industry and share in the professional development of our expanding company. Take initiative and ownership of your projects to make a difference and go the extra mile. We welcome you to apply to join our team.
Requirements:
Qualifications.
Required Knowledge/Education/Experience:
- Minimum three (3) years previous managed health care experience.
- Experience interpreting relevant federal and state regulatory requirements regarding managed health care programs and implementing compliance.
- Experience with internal and external regulatory audits, including CMS and DMHC.
- Strong knowledge of fraud and abuse laws, health care privacy laws, and health care industry standards and guidelines with ability to interpret regulatory standards into organizational policy.
- Excellent verbal, written, and interpersonal communication skills.
- Ability to handle highly sensitive and confidential information in compliance with the Health Insurance Portability and Accountability Act (HIPAA), Company confidentiality policies and procedures, and other sensitive/proprietary information.
- Strong organizational skills, detail-oriented, with ability to meet strict deadlines.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Proficiency with Microsoft Office applications, web-based technologies, virtual video platforms (Zoom, Teams, WebEx, etc.)
Highly Preferred Skills/Qualifications
- Juris Doctorate preferred.
Please note that the duties and responsibilities outlined above are summarized and may not encompass all tasks associated with the position. The nature of the role may require adaptation to changing circumstances and additional responsibilities not explicitly mentioned here. The organization reserves the right to modify, interpret, or supplement the job duties as needed.
Compensation details: 00 Yearly Salary
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