Compliance Manager in Santa Barbara, CA at Volt

Date Posted: 5/7/2018

Job Snapshot

Job Description

Are you looking for a good solid company that cares about their employees in gorgeous Santa Barbara? Then this is the opportunity for you, we are seeking a Compliance Supervisor who will oversee  the Compliance staff in day-to-day operations. You will oversees and manages fraud, waste and abuse (FWA) compliance processes and related activities. Maintains the policies and procedures that assure the Plan’s operations remain in compliance with legal, contractual, and regulatory requirements. Participates in the development and deployment of new functions to expand compliance activities with the larger mission of maintenance of an effective Compliance Program

Duties and Responsibilities

Supervises Compliance staff, with duties including but not limited to:

  • Developing and delivering new hire and ongoing training;
  • Overseeing job performance;
  • Assigning work related tasks as needed and/or as assigned by the Compliance Officer; and
  • Conducting performance evaluations.

Oversees and manages FWA compliance processes and activities, with duties including but not limited to:

  • Overseeing the process of tracking and investigating reports of alleged FWA from external and internal sources;
  • Ensuring that investigations are processed through to resolution and are reported to the appropriate parties/entities within required timeframes;
  • Managing internal/external audits, and audit findings responses and corrective action plans;
  • Oversees the development and administration of FWA training for all staff.

Collaborates with company's  operations management to ensure compliance with legal,  contractual, and regulatory requirements, with duties including but not limited to:

  • Maintenance of a system for the maintenance of policies and procedures, to ensure compliance with relevant state and federal requirements, contractual requirements, and/or industry standards;
  • Coordination of routine audits conducted by the Department of Health Care Services and the Department of Managed Health Care;
  • Oversight of the submission of operational Plan data to the Department of Health Care Services and the Department of Managed Health Care (“upstream reporting”);
  • Ensure that the Plan meets ongoing non-routine reporting requirements that are requested by the Department of Managed Health Care and Department of Health Care Services;
  • Collaboration with the Director of Government Affairs to stay abreast of changes in contractual provisions or regulations and communicate those changes to relevant staff within the organization.

Under the direction of the Compliance Officer, maintains and monitors the organization’s compliance plan, with duties including but not limited to:

  • Ensuring that Compliance projects support and achieve company's heath  Compliance Program goals;
  • Working with the Compliance Committee to ensure staff are educated and trained on the compliance program; and
  • Researching and responding to staff questions regarding regulatory compliance;
  • Development and oversight of an internal audit function;
  • Preparation of agenda for the Compliance Committee and any related subcommittees, transcription of committee minutes and maintenance of all associated records;
  • Maintains and solicits routine approval of the Plan’s Code of Ethics document
   

Education and Experience

  • Bachelor’s degree in Business, Health Care Administration or a related field required
  • Minimum of five (5) years of related experience in the healthcare industry with managed care experience preferred; or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying Three – five (3 – 5) years supervisory/management experience