Compliance Coordinator in Orange at Prospect Medical Systems

Date Posted: 1/14/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Experience:
    Not Specified
  • Date Posted:
    1/14/2021
  • Job ID:
    17258

Job Description



Compliance Coordinator

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Under the direction of the Director of Compliance, and in support of PMS VP of Compliance, this position will assist in all Prospect Medical Systems compliance program functional areas, government programs related projects, to ensure compliance with federal, state and contractual healthcare requirements are upheld. Assist and coordinate various Compliance related projects.  Assist in audit preparation and the development of reports/tools to monitor and track implementation and completion of corrective measures as it relates to overall compliance. Assists in monitoring compliance training.  Cooperates with management, collaborates with cross-functional teams and performs other duties as assigned. Knowledge of Medicaid, Medicare and Commercial regulations applicable to health plans and IPA’s required.



Job Responsibilities/Duties

  • Coordinate and perform ongoing processes supporting various Compliance initiatives such as provider and vendor exclusion screening, operational approvals and library maintenance as well as general support of other compliance technology platforms as required.  Assist with developing compliance and regulatory materials and/or training tools as needing to educate internal departments on new technology supporting federal and state regulatory changes and initiatives. 
  • Assist compliance team in maintaining incoming health plan updates related to IPA compliance program and contractual requirements and disseminate key information to lead teams internally, as needed.  Maintain internal documentation to ensure compliance and regulatory changes/updates are logged for record keeping. Maintain documentation and prepare materials for Compliance Committee and other internal workgroups as it pertains to Prospect Medical Systems Compliance Department.
  • Assist Compliance team in tracking areas of compliance and regulatory vulnerability while assisting in documenting updates for audit submissions. Coordinate and maintain master audit calendar for all health plan audits/CAPs/Readiness preparation. Work collaboratively with all departments to follow up on audit items and ensure accuracy of information provided and timely submission, as needed. Assist Prospect Medical Systems, Compliance team to track regulatory deadlines and submit various reports as it relates to other contractual requirements.
  • Assist with tracking compliance of required policy changes when modifications are needed according to a regulatory update, health plan specific department audits, CAPs or Readiness. Assist with tracking updates to HIPAA policies and procedures for Prospect Medical Systems, Compliance Department.


Qualifications

Minimum Education: High School Diploma required. Bachelor’s Degree preferred.

Minimum Experience: Minimum of 1- 1 ½ years related experience in government programs, preferably with direct experience dealing with managed care operations and/or interpreting and applying complex Medicaid and Medicare rules and policies in a healthcare administration setting. Strong computer skills, data entry, Word, Excel, PowerPoint and office equipment. Working knowledge of basic health care systems and/or IPA operations. Ability to understand and present information effectively and respond accurately to questions from business departments, outside agencies and vendors, and Management. Strong reasoning, problem-solving, project management and organization skills, with a high level of attention to detail.  Excellent verbal/written communication, relationship-building and time management skills. Excellent technical writing skills with the ability to draft policies in a clear, concise manner. Ability to adapt to changing priorities and to manage various projects simultaneously. Work independently on assigned projects. Working knowledge of DHCS, DMHC and CMS requirements is required. Speak, read, and write English proficiently.  

Req. Certification/Licensure:  None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Government Programs, IPA Operations, Project Management, Coordinator, Organizational skills, Managed Care, Medicaid, Medicare, Data Entry, Excel, PowerPoint, Word. Healthcare Requirements, Commercial Regulations.



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