Compliance Investigator II

Responsibilities

• Proficiently performs all duties of the Regulatory Specialist, independently.
• Operates independently, exercising judgement, and providing support and guidance to Regulatory Affairs and Compliance (RAC) staff.
• Encourages continuous awareness and education of unit staff, which may include development and maintenance of training materials.
• Creates and monitors daily operational reports to ensure the timely submission of privacy and FWA cases to DHCS.
• Manages the intake and ongoing maintenance of referral/inquiry platform.
• Absorbs and analyzes unit work consistent with established criteria and provides education/training to unit staff as needed.
• Maintains awareness and understanding of regulatory requirements that govern unit responsibilities.
• Makes strategic recommendations to improve the accuracy, quality, and/or reporting of case investigations based on audit observations.
• Leads or participates in Regulatory Affairs unit projects and has the capacity to represent unit in cross-departmental projects.
• Assists Regulatory Affairs Manager with developing and maintaining compliance training program including but not limited to: updating new hire compliance trainings and annual training materials, conducting targeted department trainings, acting as a trainer for the Regulatory Affairs unit, and assisting with backup trainer duties.
• Supports regulatory submission process including awareness of deliverables, ad hoc and routine, and completeness and timeliness of submissions.
• Assists Regulatory Affairs and Compliance unit with the administrative functions to support unit meetings, workgroups, projects and external audits.

Qualifications

• Bachelor’s degree in relevant field preferred or equivalent combination of education and experience; minimum of two (2) years’ experience as a Regulatory Affairs Specialist or relevant experience in managed care with knowledge of the Medi-Cal, and NCQA requirements, and preferably Medicare and Knox Keene.
• Experience with the investigation and reporting of HIPAA and FWA related incidents.
• Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Project, typing speed of 30 wpm.
• Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.