Billing, Bookkeeping, Check Processing, Claims Management, Comparative Analysis, ERISA (Employee Retirement Income Security Act of 1974), Environmental Compliance, Environmental Management Systems, Federal Government, File Maintenance, Healthcare Management, Information Systems/Technology IS/IT Administration, Insurance, LAP (Link Access Procedure), Leadership, Maintain Compliance, Managed Care, Medicare, Operations Processes, Policy Development, Procedure Development, Quality Management, Regulations, Regulatory Compliance, Regulatory Reports, Regulatory Requirements, Reporting Skills, Spill Prevention Control and Countermeasure (SPCC), Stormwater Management, Team Lead/Manager, Time Management, Water Resource Management
Must be able to work onsite up to 3 days per week
6 months contract initially
GENERALFUNCTION
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.
MAJORDUTIESANDRESPONSIBILITIES
¢ 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/utilizationmanagementauditresultsandfindingsincollaborationwiththeManager-Compliance,ClaimsManager/Team Leader, and Quality Management VP/Team Leade rand Clinical Director.
¢Prepares documents to be presented to the Quality Management Committee,PublicPolicyCommittee,BoardofDirectors,andManagementTeam.
• Providesoversightwiththecomplianceworkplanandmonitoringfunctionsandactivitiesincludingriskassessment.
¢ Assists with the Language Assistance Program(LAP)activitiessuchasstafflanguagefluencyassessment,monitoringtheenrolleeassessmentreport,CustomerServiceDepartmentcalllog,andpreparingandmai
Prepares reports,maintains files,and communicatesthedata&informationassociatedwithlocal,state,andfederalregulatoryguidelinesforthenetworkincludingthosesetforthbyEPA,StateEPA
’s,CalEPA,CaliforniaCUPA’sandotherstateandlocalenvironmentalregulatoryagencies.Supportscompliancewithfederal,state,andlocalenvironmentallaws
¢Ability to work effectively with regulatory agencies is required while communicating with facilities throughout U.S.and Canada regarding permits,inspections,and compliance requirements
¢Maintain general and upto date knowledge of fire protection systems and associated general regulatory compliance requirements
¢Acquire approval for environmental compliance related payable sand track invoices & check requests
¢ Manage Water Discharge Monitoring Reports
¢ General knowledge of SPCC plans and Storm water 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
¢ GeneralknowledgeofCaliforniaspecialwastesastheyrelatetoouroperations
¢ General understanding of Environmental Management Systems
¢Maintaindocumentfilespertainingtoaudits&observationsofworkforceperformancewithregardtoenvironmentalcompliance
¢Throughobservationofdocumentssuchasreports,permits,&inspectionforms,beabletodetectpotentialenvironmentalcomplianceproblemsofanaccounting,bookkeeping,andclericalnature.
¢ Facilitate,arrange,andconductenvironmentalrelatedtrainingandorientationasneeded
¢ Trackinformationonenergyandresource-efficientprojects&programs.ThiscouldincludeenergyconservationprogramsandfutureLEEDcertifications.