Compliance Consultant IV Medicare Finance Compliance (Oakland or Pasadena) Oakland, CA
Compliance Consultant IV-Medicare Finance Compliance
Kaiser Permanente
Oakland or Pasadena, CA
Researches, plans, implements, and monitors a broad portfolio of compliance systems and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws, as well as overseeing the protection of organizational assets. On an on-going basis, researches and interprets regulations and laws to establish compliance standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new compliance initiatives, products, or annual processes.
Qualifications:
Basic Qualifications:
- Required: Eight (8) to twelve (12) years of heath care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
- Four (4) year or clinical degree
-Experience with interpreting Medicare laws, regulations, memorandums and manuals and ability to identify and partner with business to communicate impact and compliance expectations
-Familiarity with Medicare Advantage, 1876 Cost, and Part D reimbursement laws and regulations as wells as hospital Medicare and Medicaid Cost Reporting
-Specific knowledge of at least one of the following Medicare reimbursement and finance topics isrequired: Medicare Advantage and Part D Bids, Part D payment calculations and risk corridors, HMO Cost Reports and Hospital Cost Reporting.
-Ability to lead and manage operational and tactical aspects of multiple projects at the same time
-Plans, executes, and finalizes projects according to strict deadlines
-Ability to collaborate with multiple functions and departments, across various levels of the organization
-Strong critical thinking, problem solving, and oral and written communication skills
- Advanced knowledge of health care compliance policies, practices, and systems.
- Contributes to the development of compliance principles, theories, and concepts.
- Broad knowledge of health care industry practices and standards.
- Ability to draft and revise documents including policies, standards, analyses, and reports.
- Strong Project management skills
- Advanced knowledge of health care and related compliance issues.
Preferred Qualification
Experience with integrating compliance within system/application implementations preferable
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