Regulatory and Reporting Specialist

Job description

Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. Support all aspects of our Appeals and Grievance (A& G), Care Management (CM), and Utilization Management (UM) compliance program for Medicare, and Medicaid lines of business. Assume the primary role of interfacing with the Compliance department, Auditors, Vendors and staff for purposes of monitoring and ensuring compliant operations. Interface with the Compliance Department and Fraud, Waste and Abuse teams to evaluate and address fraudulent activities impacting these departments. Conduct internal audits, support external audits, develop policies and procedures, and ensure departmental compliance. Essential Responsibilities: * In partnership with Compliance staff and leadership, develop auditing and monitoring plans to assess compliance with all State, Federal and internal business rules and regulations. * Serve as an inter-departmental liaison for compliance and FWA activities. * Inform all business operations and workflow decisions to ensure that programs are compliant with State, Federal an internal business rules and regulations. * Be fully informed and ensure compliant processes are in place on all business operations, including but not limited to: business processes, OIG status, FWA programs, Helpdesk operations including call monitoring, Communication strategies, Website publications, Claims adjudication, and all vendor managed programs. * Maintain a current working knowledge of all applicable Medicare, and Medicaid rules and regulations including assessment, impact report and training on any new rules or regulations to all impacted departments. * Conduct frequent monitoring activities of all business operations, publish results and report out to Leadership, Compliance Department, quality committees and other PacificSource leadership teams as applicable. * Respond to all compliance related inquiries from internal Compliance Department Staff and external Auditors in a timely, professional and accur To view the full job description please use the link below. https://www.aplitrak.com/?adid=YmJnZW5lcmljLjIwNzA0Ljg3NjRAcGFjaWZpY3NvdXJjZWNvbXAuYXBsaXRyYWsuY29t