Compliance Administrator

The Administrator-Compliance (Programs) is responsible for preparing, researching, and completing the regulatory reports, amendment filings, and business partners/carrier reporting requirements. This includes operational processes and programs to assure compliance with various regulatory requirements such as Medicare Advantage (MA), Department of Managed Health Care (DMHC), Department of Insurance (DOI), and Employee Retirement Income Security Act (ERISA).

Compares and evaluates possible courses of action and makes recommendations to the Compliance Manager or leadership team. Assists the Compliance Manager in assuring compliance with policies, procedures, and requirements set by state and federal agencies. Modifies policies and procedures as necessary.

MAJOR DUTIES AND RESPONSIBILITIES

• Thoroughly prepares, researches, and completes DMHC reports and amendment filings, business partners/carrier reporting requirements, and any other requirements set by state and federal agencies.
• Reviews related regulations and performs analysis to assure all requirements are met and filed within the deadline.
• Thoroughly and timely tracks reporting deadlines by month and logs all in-process and completed reports.
• Prepares and/or oversees internal claims and quality management/utilization management audit results and findings in collaboration with the Manager-Compliance, Claims Manager/Team Leader, and Quality Management VP/Team Leader and Clinical Director.
• Prepares documents to be presented to the Quality Management Committee, Public Policy Committee, Board of Directors, and Management Team.
• Provides oversight with the compliance work plan and monitoring functions and activities including risk assessment.
• Assists with the Language Assistance Program (LAP) activities such as staff language fluency assessment, monitoring the enrollee assessment report, Customer Service Department call log, and preparing and mailing related documentation.
• Prepares reports, maintains files, and communicates the data & information associated with local, state, and federal regulatory guidelines for the network including those set forth by EPA, State EPAs, CalEPA, California CUPAs, and other state and local environmental regulatory agencies.
• Supports compliance with federal, state, and local environmental laws.
• Ability to work effectively with regulatory agencies is required while communicating with facilities throughout the U.S. and Canada regarding permits, inspections, and compliance requirements.
• Maintain general and up-to-date knowledge of fire protection systems and associated general regulatory compliance requirements.
• Acquire approval for environmental compliance related payables and track invoices & check requests.
• Manage Water Discharge Monitoring Reports.
• General knowledge of SPCC plans and Stormwater management plans as they relate to our operations.
• Familiarity with the Clean Air Act as it relates to our operations.
• Familiarity with EPCRA requirements as they relate to our operations.
• General knowledge of California special wastes as they relate to our operations.
• General understanding of Environmental Management Systems.
• Maintain document files pertaining to audits & observations of workforce performance with regard to environmental compliance.
• Through observation of documents such as reports, permits, & inspection forms, be able to detect potential environmental compliance problems of an accounting, bookkeeping, and clerical nature.
• Facilitate, arrange, and conduct environmental-related training and orientation as needed.
• Track information on energy and resource-efficient projects & programs. This could include energy conservation programs and future LEED certifications.