Compliance Specialist

Astiva Health; California; On-site; USD 65,000 - 90,000; Full time

Job summary

Astiva Health, Inc. in Orange, CA is seeking a Compliance Specialist to help develop and maintain its Compliance Program and support daily operations to meet state and federal regulations.

The role involves collaboration with stakeholders, reporting to senior leadership, staff training on policies, and investigating complaints to ensure accountability across business units.

Qualifications

• Bachelor's degree or equivalent experience required.
• Two (2) years experience with a Medicare Advantage Organization or PDP sponsor.
• Knowledge of CMS Medicare Guidelines.
• Ability to work effectively in a team environment.
• Ability to handle multiple tasks simultaneously.
• Proficient in MS Word and Excel.

Responsibilities

• Collaborate with internal stakeholders on Compliance issues.
• Prepare reports, analyses, and recommendations under the direction of General Counsel/Compliance Officer.
• Consult with legal and advise leadership on compliance matters.
• Develop and provide employee training on compliance policies and reporting systems.
• Ensure compliance with state and federal agencies by studying legislation and enhancing the compliance program.
• Provide guidance interpreting policies related to compliance issues.
• Investigate sales allegations and document findings.
• Track complaints in the Medicare Compliance database and link relevant documents.
• Assist management with internal reporting of complaints and status updates.
• Identify, investigate, and report compliance issues and violations.
• Maintain records of compliance activities.
• Communicate with government agencies.
• Assist in preparing compliance reports for Board and Compliance Committee.
• Handle all compliance and ethics matters with confidentiality.
• Regular attendance and other duties as assigned.

Education

Bachelor's degree

Two (2) years Medicare Advantage Organization experience

Knowledge of CMS Medicare Guidelines

Ability to work effectively in a team environment

Ability to prioritize multiple tasks

Proficiency in MS Word and Excel

Tools

MS Word

Excel

Job description

Description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY:

The Compliance Specialist will play a critical role in the develop and maintenance of Astiva's Compliance Program. In this role, the Compliance Specialist will support the daily operations of the Compliance Program, implement proper preventative compliance programs, investigating complaints and execute relevant policies and procedures to ensure all business units and activities meet state and federal regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Collaborate with internal stakeholders on Compliance issues.
• Under the direction of the General Counsel/Compliance Officer, prepare reports, related analyses, and make recommendations to assist management in ensuring compliance and improvement of internal controls.
• Consult with the legal department and advise leadership and management on compliance matters.
• Develop and provide employee training on compliance policies, practices, and reporting systems.
• Ensure compliance with state and federal agencies by studying existing and new legislation and facilitating the compliance program
• Provide guidance and information by interpreting policies and procedures related to compliance issues.
• Conduct thorough investigations of sales allegations, identifying compliance concerns and documenting findings accurately.
• Track complaints in the Medicare Compliance database and link all relevant documents.
• Assist the Management team with internal reporting of complaints, including populating reports that demonstrate complaint volume and investigation statuses.
• Identify, investigate, and report compliance issues, irregularities, and violations.
• Maintain record of compliance activities.
• Communicate with government agencies.
• Assist in the preparation of compliance reports, including reports for the Board of Directors and Compliance Committee.
• Handle all compliance and ethics matters with sensitivity and maintain strict confidentiality of all work material and activities.
• Regular and consistent attendance
• Other duties as assigned

Requirements

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE:

• Bachelor's degree, or equivalent career experience, required
• Two (2) years prior experience at a Medicare Advantage Organization or Prescription Drug plan Sponsor
• Knowledge of risk assessment concepts
• Demonstrated understanding of CMS Medicare Guidelines.
• Ability to work effectively and participate in a team environment.
• Ability to handle and prioritize multiple tasks simultaneously.
• Proficient in MS Word and Excel

BENEFITS:

• 401(k)
• Dental Insurance
• Health Insurance
• Life Insurance
• Vision Insurance
• Paid Time Off

LANGUAGE: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.

MATHEMATICS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s Aff...statement.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.

While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.