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For your reference, we have included the original job posting below.
COMPLIANCE AND REGULATORY SPECIALIST
Job Number:
74552072
Company Name:
Health Plan of San Mateo
Job Location:
South San Francisco, CA US
Job Categories:
Healthcare & Medical Insurance
Minimum Education:
4-Year College Degree
COMPLIANCE AND REGULATORY SPECIALIST
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a Compliance and Regulatory Specialist, who will oversee compliance activities and processes to ensure compliance with all applicable Medicare laws, regulations, and CMS instructions.They will be involved in the documentation of processes, policies, and procedures necessary for maintenance of the CMS contract and to ensure maintenance of HPSM’s Knox-Keene License by assisting in the implementation of state statutes and regulations; as well as ensure compliance with DHS and the Managed Risk Medical Insurance Board’s (MRMIB) contracts.
Primary duties:
Conduct regular and on-going review and analysis of all relevant contractual provisions and state and federal statutes and regulations; complete associated reporting requirements.
Develop policies and procedures to conform to relevant state, federal, and/or industry standards and requirements and coordinate efforts with appropriate departmental staff to ensure implementation.
Serves as one of the liaisons to state agencies and coordinates responses to requests for information, including audit requests and preparation of Corrective Action Plans.
Research questions from staff regarding regulatory compliance.
Maintain a strong working knowledge of local, state, and national health issues affecting publicly funded health care organizations and HPSM.
Assist in developing the MAA claim plan, attend training sessions and meetings involving MAA, assist in training staff and answering questions regarding MAA activities and on local, state, and federal MAA requirements (G).
Benefits Information:
Excellent benefits package offered including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; 457 Plan in lieu of social security (7.5% of salary/HPSM paid); retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Requirements:
Education and Experience: Equivalent to a Bachelor’s degree in health care planning or a related field. Equivalent to three years experience in a managed care environment. Related Master’s degree may substitute for work experience. Responsibilities in a regulatory environment.
Knowledge of: Medicare and Medi-Cal programs.
Ability to: Analyze and interpret legal and contractual language.Demonstrate strong analytical problem solving skills with initiative and ability to work independently.Interact with a variety of people in difficult instances. Work effectively as part of a team across organizational structure.Proficiently utilize personal computer including word processing, database, and spreadsheet software; effectively perform internet searches. Demonstrate professional writing and communication skills
