Health Plan Compliance Specialist
: Job Details :

We are so glad you are interested in joining Sutter Health!Organization:Sutter Health Plan - ValleyPosition Overview:Supports a variety of legislative and regulatory change management activities to ensure sustainable operational processes and internal controls are implemented in compliance with state and federal regulatory requirements. Collaborates with Ethics & Compliance Services staff to track and monitor legislative and regulatory actions and gather regulatory intelligence. Coordinates with internal stakeholders and legal counsel to conduct regulatory analyses and impact assessments. Actively participates in internal and external regulatory workgroup meetings. Partners with business operational units and all levels of management to ensure operational and procedural compliance with legislative and regulatory criteria. Serves as a subject matter expert (SME) and resource person to support multiple regulatory implementation projects, filings, and reports.Must have advanced knowledge and understanding of California regulations that govern commercial health plan operations, including the Knox-Keene Act and Department of Managed Health Care (DMHC) standards.This is a work from home role with some onsite requirements. The successful candidate will live within the Sutter footprint.Job Description:EDUCATION:Equivalent experience will be accepted in lieu of the required degree or diploma.* Bachelor'sTYPICAL EXPERIENCE:* 2 years recent relevant experienceSKILLS AND KNOWLEDGE:* Advanced knowledge and understanding of current regulations that govern healthcare and commercial health plan operations, including the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws.* In-depth knowledge of healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, including a general knowledge of basic legal terminology, principles, procedures and available legal resources.* Business acumen and exceptional analytic skills with the proven ability to provide innovative solutions to complex problems and build consensus.* Possesses written/verbal communication, interpersonal, and presentation skills to explain complex healthcare plans or sensitive information clearly and diplomatically to diverse audiences.* Exceptional attention to detail with time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines and budgets* Proficient computer skills, including advance competency in Microsoft Office Suite, Visio, and Project.* Manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.* Identify potential healthcare plan concerns and compliance issues, and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem.* Maintain strict confidentiality and ensure the privacy of each patient's protected health information (PHI).* Make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.* Direct, prioritize, and drive multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget.* Negotiate effectively with staff, senior management, vendors, media partnerships, external agencies and organizations.* Build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve corporate goals and objectives.Job Shift:DaysSchedule:Full TimeShift Hours:8Days of the Week:Monday - FridayWeekend Requirements:NoneBenefits:YesUnions:NoPosition Status:ExemptWeekly Hours:40Employee Status:RegularSutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.Pay Range is $44.28 to $66.42 / hourThe salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.