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Regulatory Affairs & Compliance Specialist - Risk Adjustment Job in San Francisco, AA

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Job Title: Regulatory Affairs & Compliance Specialist - Risk Adjustment

Employer:OnLok Lifeways
Required Experience:3 to 4 years
Location:San Francisco, AA
Date Posted:9/6/2019

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

Applying

Apply Here:

For more Information:

Luis Paredes

Phone: 855-453-3165

Email: lparedes@onlok.org



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