Compliance Manager
PacificSource

Job Info

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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, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Position Overview: The Compliance Manager, Enterprise manages the overall enterprise-wide functions of the Corporate Compliance Plan at the direction of and in collaboration with the Corporate Compliance Officer. Functions include, the development and oversight of the Fraud, Waste and Abuse program implementation, the HIPAA program, and the Delegation Oversight program as each program translates into an annual compliance work plan, risk assessments, monitoring, compliance training, development and implementation of compliance policies and procedures and ensuring compliance with state and federal compliance program laws and regulations.

Essential Responsibilities:

• Coordinate business activities by maintaining collaborative partnerships with key departments.
  
• Actively participate as a key team member in manager/supervisor meetings.
  
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
  
• Oversee and manage the day-to-day functions of the enterprise compliance programs: Payment Integrity/Fraud, Waste and Abuse, HIPAA, and Delegation Oversight.
  
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
  
• Collaborate with the Corporate Compliance and Privacy Officer to develop, implement and maintain a comprehensive HIPAA program that includes policies, procedures, tools and forms.
  
• Partner with the Corporate Compliance and Privacy Officer and the FWA Program Manager to build, develop, and maintain the Payment Integrity/FWA Program to prevent, detect, and correct provider, member, and imposter fraud, waste, and abuse.
  
• Partner with the Corporate Compliance and Privacy Officer and the Delegation Oversight Program Manager to build, develop and maintain a comprehensive program to monitor compliance with delegated vendor contractual requirements for auditing, monitoring, reporting, and corrective actions.
  
• Manage the enterprise compliance communication process to ensure updates are received, summarized, catalogued, and disseminated to the appropriate staff and stakeholders, including delegated entities when applicable.
  
• Collaborate with the Corporate Compliance and Privacy Officer to ensure productive and beneficial relationships with state and federal agencies, when applicable.
  
• Establish and maintain a comprehensive knowledge and understanding of regulatory requirements related to compliance program effectiveness and serve as an internal resource on matters related to enterprise compliance.
  

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
  
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  
• Perform other duties as assigned.
  

SUCCESS PROFILE

Work Experience: Minimum 5 years of experience in compliance in a commercial, managed care, or health insurance company required. Broad healthcare compliance experience including payment integrity, fraud waste and abuse, HIPAA, and delegation oversight preferred. Prior supervisory experience required. Ability to research complex, legal, regulatory, and contractual documents for interpretive purposes. Experience in navigating the CMS, OIG, and OCR websites and strong familiarity with regulatory research. Experience in Medicare and Medicaid managed care/health insurance preferred.

Education, Certificates, Licenses: Bachelor's degree in business administration, healthcare, or related field required. Master's degree preferred. Healthcare compliance certification (CHC) preferred.

Knowledge: Strong working knowledge of commercial regulations is required. Working knowledge of Medicare/Medicaid is preferred, but not required. Computer proficiency in a Windows environment, including Microsoft Office Suite.

Competencies

• Building Trust
  
• Building a Successful Team
  
• Aligning Performance for Success
  
• Building Partnerships
  
• Customer Focus
  
• Continuous Improvement
  
• Decision Making
  
• Facilitating Change
  
• Leveraging Diversity
  
• Driving for Results
  

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% of the time.

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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