Healthcare Compliance Investigator

ADP, Inc.; Grants Pass (OR); On-site; USD 36,000 - 41,000; Full time

Benefits offered by this job

Health insurance

401(k) retirement plan

Wellness programs

Flexible scheduling

Job summary

AllCare Health in Grants Pass, Oregon is seeking a Compliance Specialist to support the enterprise-wide Corporate Compliance Program, help detect, correct and prevent violations, and assist the Chief Compliance Officer with investigations, policies, training, and reporting.

Responsibilities include conducting investigations with data analytics and preparing reports for regulators such as OIG, CMS and OHA, maintaining confidentiality, and aiding in risk assessments.

Qualifications

• Bachelor's degree in criminal justice, fraud management, or healthcare administration preferred.
• 1–2 years related experience in criminal justice, fraud management, investigations, or healthcare administration.
• Knowledge of CPT/ICD-10 codes, Medicare guidelines, OIG priorities, HIPAA, FWA and Compliance CFRs.

Responsibilities

• Investigations & Risk Management: manage investigations for potential compliance violations and provide risk guidance.
• Regulatory Guidance & Reporting: serve as SME on healthcare regulations (Stark, AKS, False Claims Act) and report findings.
• Maintain knowledge of federal and state laws and assist in audits by regulators.
• Assist in enterprise risk assessments and develop monitoring work plans.
• Maintain confidentiality and communicate effectively with internal teams.

Skills

Investigations

Data analytics

Report writing

HIPAA knowledge

Communication

Education

Bachelor's degree in criminal justice, fraud management, or healthcare administration

Job description

AllCare Health in Grants Pass, Oregon is seeking a Compliance Specialist to support the enterprise-wide Corporate Compliance Program, help detect, correct and prevent violations, and assist the Chief Compliance Officer with investigations, policies, training, and reporting.

Responsibilities include conducting investigations with data analytics and preparing reports for regulators such as OIG, CMS and OHA, maintaining confidentiality, and aiding in risk assessments.