Compliance Specialist

Astiva Health; Orange (CA); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Job summary

Astiva Health, located in Orange, CA, is seeking a Compliance Specialist to develop and maintain its Compliance Program and support daily operations. This on-site role involves investigating complaints, implementing preventative compliance measures, and reporting to leadership and the Board.

You will collaborate with legal and management to ensure state and federal regulatory adherence. Requirements include a Bachelor's degree or equivalent experience, 2 years in Medicare Advantage or PDP, and

Qualifications

• Bachelor's degree or equivalent experience is required.
• Two years of prior experience with Medicare Advantage Organizations or PDP plans.
• Knowledge of risk assessment concepts is required.
• Familiarity with CMS Medicare Guidelines.
• Ability to work in a team and manage multiple tasks simultaneously.
• Proficiency in MS Word and Excel.

Responsibilities

• Collaborate with internal stakeholders on Compliance issues.
• Prepare reports and analyses under guidance of General Counsel/Compliance Officer.
• Advise leadership on compliance matters with the legal department.
• Develop and deliver employee training on compliance policies.
• Ensure compliance with state and federal regulations across business units.
• Investigate sales allegations and document findings.
• Track complaints in the Medicare Compliance database and manage documentation.
• Assist in internal reporting of complaints and investigation statuses.

Skills

Risk assessment concepts

CMS Medicare Guidelines

Team collaboration

Multitasking

Education

Bachelor's degree or equivalent

Tools

MS Word

MS 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. This position is fully on-site at our offices in Orange, CA.

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 Affi... 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.