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    Compliance Coordinator I - San Jose, United States - Santa Clara Family Health Plan

    Santa Clara Family Health Plan
    Santa Clara Family Health Plan San Jose, United States

    3 weeks ago

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    Description

    FLSA Status:
    Non-Exempt

    Department:
    Compliance

    Reports To:
    Manager, Compliance

    Employee Unit :
    Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521


    GENERAL DESCRIPTION OF POSITION

    The Compliance Coordinator I assists with the implementation and management of the compliance program in accordance with state and federal regulatory requirements and SCFHP policies and procedures as set forth for each line of business.


    ESSENTIAL DUTIES AND RESPONSIBILITIES
    To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

    Collect and track all information needed to complete and submit regulatory state and federal reports in a timely manner.


    Assist in the preparation of regulatory filings, including collection, tracking, and maintenance of all information necessary to complete the filings in a timely manner.


    Responsible for HIPAA related reviews, including the tracking and evaluation of HIPAA requests, as well as gathering, tracking, and evaluating all privacy-related incidents.


    Preparation and execution of the Plan's compliance trainings and annual Compliance Week activities, which includes tracking completion of mandatory compliance trainings.

    Ensure training materials related to compliance policies are always up-to-date.


    Establish a thorough working knowledge of SCFHP's policies and procedures and encourage staff and stakeholder compliance with established SCFHP policies and procedures.


    Assist in coordinating regulatory audits of SCFHP business units (internal audits) and vendors, delegates and other business partners (external or contract audits).

    Prepare and distribute agendas and supplemental materials, schedule meeting(s) according to information and parameters established by the organizer.

    Conduct, coordinate, and document training with SCFHP staff, vendors and delegates.


    Collaborate with internal departments to develop, revise, and maintain all documents related to internal, external and contract audits, including but not limited to audit tools, reports, pre-audit documents, logs, schedules and corrective action plans (CAP).

    Maintain compliance reporting calendars which track the regulatory reports that SCFHP submits to its regulators.

    Prepare and coordinate all Joint Operations Committee (JOC) meetings, documents, and agendas and encourage active engagement in the JOC. Prepare minutes of meetings for review by the manager in a timely manner.

    Promote and adhere to the SCFHP's Code of Conduct and the elements of the Compliance Program.

    Distribute and provide general direction for business unit responses to HPMS memos/MMCD all-plan letters and monitor related tasks.

    Perform other related duties as required or assigned.

    REQUIREMENTS – Required (R)

    Desired (D)
    The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

    Bachelor's Degree in Healthcare, Business, or related field, or equivalent experience, training or coursework. (R)

    Minimum one year of experience in managed care or in a healthcare setting in position(s) that included compliance responsibilities. (R)

    Working knowledge of healthcare compliance and/or Medicare and/or Medi-Cal regulations. (D)

    Ability to consistently meet compliance accuracy and timeline requirements by achieving regulatory standards. (R)

    The ability to form positive, professional relationships with regulators, providers, and stakeholders. (R)


    Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the Compliance Department operations as dictated by business needs.

    (R)


    Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and PowerPoint.

    (R)

    Ability to use a keyboard with moderate speed and a high level of accuracy. (R)


    Excellent communication skills including the ability to express oneself clearly and concisely when interacting with SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing and the ability to remain calm and de-escalate tense situations.

    (R)

    Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)

    Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)

    Ability to maintain confidentiality. (R)

    Ability to comply with all SCFHP policies and procedures. (R)

    Ability to perform the job safely and with respect to others, to property and to individual safety. (R)


    WORKING CONDITIONS
    Generally, duties are primarily performed in an office environment while sitting or standing at a desk.

    Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.


    PHYSICAL REQUIREMENTS
    Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

    Mobility Requirements:
    regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)

    Lifting Requirements:
    regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)

    Visual Requirements:
    ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)

    Dexterity Requirements:
    regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)

    Hearing/Talking Requirements:
    ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)

    Reasoning Requirements:

    ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail.

    (R)


    ENVIRONMENTAL CONDITIONS
    General office conditions. May be exposed to moderate noise levels.

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