On Lok Lifeways
We are a non-profit committed to our
participants. On Lok Lifeways PACE long term senior care is provided by On Lok
Senior Health Services, a 501(c)(3) non-profit
Dedicated To The Care Of Elders
On Lok, Inc. is a not-for-profit
organization founded in the early 1970s by a group of citizens concerned about
the plight of elders and the lack of long term options in the community. On
Lok, Inc. serves as the administrative arm of a group of five affiliated non-profit
organizations. Its functions include research and development, human resources,
fundraising and management information systems.
We understand the importance of a system
that works together. Your expertise, drive and passion can help us carry out our
mission to improve lives and advance healthcare.
Join our team of leaders to begin a
rewarding career!
Position Summary
Under the direction and supervision of
the Director of Regulatory Affairs and Compliance, the Regulatory Affairs and
Compliance Specialist 2 helps to ensure On Lok Senior Health Services remains
compliant with the regulatory, licensing, and contractual requirements set
forth by the Centers for Medicare and Medicaid Services (CMS), the California
Department of Health Care Services (DHCS), and the California Department of
Public Health (DPH). The Regulatory Affairs and Compliance Specialist 2
performs regulatory compliance activities and implements monitoring initiatives
related to Program of All- Inclusive Care for the Elderly (PACE).
Duties / Responsibilities
Regulatory Communications
• Monitor regulatory communications from
CMS, DHCS, and DPH.
• Participate in conference calls and
training webinars from regulators and/or associations.
• Review and analyze changes and/or
updates to regulatory requirements to assess the impact to PACE programming and
reporting.
• Communicate and disseminate guidance
to internal departments and track implementation and appropriate training.
Policies and Procedures
• Coordinate and collaborate with
internal departments to develop, review, and revise policies and procedures.
• Provide expertise and guidance to
internal partners to ensure that policies and procedures are compliant with
regulatory, licensing, and contractual requirements.
Regulatory Reports and Filings
• Assist with the coordination,
tracking, and filing of routine and ad-hoc reports and filings to regulatory
agencies as appropriate.
• Provide guidance to internal
departments regarding reporting requirements.
• Review and quality check data and information
presented in reports prior to submission to regulatory agencies.
Regulatory Audits
• In coordination with the supervisor,
the Regulatory Affairs and Compliance Specialist 2 will facilitate site visits
from federal and state regulators.
• Develop cross-departmental work plans
for external regulatory audits.
• Collect, review, and quality check
deliverables and liaise with internal departments during audit preparation.
• Conduct mock audits and staff
interviews.
• Assist internal partners to develop
corrective action plans in response to audit deficiencies and monitor progress
with internal departments.
Regulatory Compliance Monitoring
• Monitor internal processes and
functions to facilitate compliance with regulatory requirements, including but
not limited to:
• Assessing risks
• Developing monitoring tools and
templates
• Identifying trends
• Drafting reports
• Presenting results and recommendations
for improvements to management
• Monitor and track recommendations as
necessary.
Regulatory Research
• Research and analyze regulatory issues
as they arise. In consultation with supervisor, provides appropriate guidance
to internal departments.
Other Regulatory Compliance Duties
• Perform other regulatory compliance
activities and monitoring initiatives as assigned by supervisor.
QUALIFICATIONS (knowledge, Skills,
Abilities)
• Bachelor's degree in health care
administration, business administration, or related field from an accredited
college.
• Four to six years of related
experience in regulatory or compliance area with a health care organization or
a health care provider preferred.
• Excellent judgment with high
integrity, flexibility, initiative, and willingness to participate in various
regulatory activities and monitoring efforts.
• Excellent organizational, analytical,
critical thinking, problem-solving, verbal, and writing skills.
• Excellent time management and
attention to detail.
• Ability to work well both
independently and cross-departmentally in a matrix environment.
• Knowledge of pertinent regulatory
requirements and/or guidelines from CMS, DHCS, and DPH.
• Ability to read, analyze, and provide
sound interpretation of rules, regulations, and guidelines.
• Ability to write clear, concise
reports, summaries, business correspondence, and policies and procedures.
• Ability to effectively present and
represent On Lok's interest externally with auditors.
• Ability to effectively present
information and respond to inquiries from On Lok employees, regulatory
agencies, and others, as necessary.
• Proficient with MS Office (Word,
Excel, and PowerPoint) and Adobe Acrobat Professional.
REGULATORY AFFAIRS &
COMPLIANCE SPECIALIST 2 ADDENDUM RISK ADJUSTMENT
Additional Duties/Responsibilities
• Provide oversight for the risk
adjustment and encounter data reporting process by monitoring activities
including submission, reconciliation, and error resolution to verify compliance
with CMS and DHCS requirements. Provide support to the risk adjustment and
encounter data reporting steering committee as it pertains to compliance
activities.
• Monitor regulatory communications from
CMS and DHCS as it pertains to the risk adjustment and encounter data reporting
requirements. Participate in conference calls and training webinars from
regulators and/or associations. Review, analyze, and interpret changes and/or
updates to the risk adjustment and encounter data reporting regulatory
requirements to assess its impact to PACE. Communicate and disseminate guidance
to internal departments and tracks implementation and appropriate training.
• Coordinate with supervisor, facilitate
risk adjustment and encounter data reporting audits from federal and state
regulators. Conduct mock risk adjustment data validation (RADV) audits for both
internal and external providers. Prepare reports communicating audit results to
senior leadership and internal managers. Assist with developing corrective
action plans in response to audit deficiencies.
• Research and analyze regulatory issues
for risk adjustment and encounter data reporting as they arise. In consultation
with supervisor, provide appropriate guidance to internal departments.
QUALIFICATIONS (knowledge, Skills,
Abilities)
• At least four years minimum of related
experience in regulatory affairs and compliance and at least two (2) years of
related experience in, risk adjustment (CMS-HCC models), and/or medical record
auditing with a health care organization or a health care provider preferred.
• Background in risk adjustment coding
preferred.
• Electronic Health Records (EHR) system
experience (NextGen, EPIC, or Cerner) preferred.
• Ability to interpret, analyze, and
communicate data trends to internal stakeholders.
• Highly analytical and
solutions-oriented.
On Lok's Employee Benefits include
(eligible for any regular position for 20 hr/wk or more):
• Medical, Dental, and Vision coverage
• Retirement Savings Plan 403(b) and
Term Life/AD&D Insurance
• Flexible Spending Account, Commuter
Checks, MLA scholarships, Employee Assistance Program (EAP)
• Pet Insurance and additional discounts
• Holidays (10 per year), vacation time,
sick leave, and long-term disability insurance