Medicare Compliance Analyst II or III

3 weeks ago

Portland, United States Cambia Health Solutions, Inc Full time

Compliance Analyst II or III

Work Remotely from Oregon, Washington, Idaho or Utah

Primary Job Purpose

As a member of the Compliance team, the Compliance Analyst is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state, federal and other laws. Duties may include, but are not limited to, risk assessment, training, monitoring, auditing, external audit coordination, investigation, root cause analysis, regulatory implementation, control assessment, reporting, and corrective actions. Grade level at hire and upon promotion will be based on such factors as experience, performance, complexity and scope of work assigned, knowledge, and influence skills. This role may be specific to a product line or area, or may have a broader scope. Special projects may be assigned as needed.

We are seeking an individual with Medicare compliance experience to assist in prevention, detection, and remediation activities. Experience in risk adjustment compliance (Medicare and ACA) as well as a coding certification is preferred.

General Functions and Outcomes

  • Overall responsibilities include specific and/or portions of the following functions that relate to an effective compliance program utilizing as a basis the seven elements of compliance.

  • Duties include aspects of the preparation, planning, coordination, project management, submission, administration, monitoring and auditing of the Cambia compliance program which serves to oversee activities related to requirements, laws and regulations to prevent, detect and remediate compliance issues of the company.

  • Responsibility for producing and maintaining policies and desk manuals for position.

  • Works as a team with other staff members assigned in either a supporting or leading role.

  • Participating in the annual risk assessment process.

  • Ensuring materials, reports, and other documents are written in an understandable and concise style.

  • Project management and implementation.

  • Participating, supporting and serving in regular meetings, including divisional and cross-divisional committees as needed.

  • Core Competencies: risk assessments, training, policies and procedures, training, monitoring, auditing, root cause analysis, and corrective actions.

  • Additional Competencies: external audit coordination, implementations, control assessments, delegation oversight, data validation, marketing material oversight, DDE/FDR oversight.

Minimum Requirements (Compliance Analyst II and III)

  • Proven ability to deliver effective Core Compliance activities, including, monitoring, auditing, root cause analyses, and corrective actions.

  • Skilled in project management and delivery including proven ability to initiate and manage multiple projects and priorities.

  • Excellent written and oral communication and presentation skills.

  • Excellent research and analytics skills, with proven ability to distill actionable, practical advice from diverse sources and opinions. Legal research skills preferred.

  • Proven ability to influence effectively at all levels of the organization.

  • Excellent independent judgment and decision-making skills.

  • PC literate with office computer software - Word, Excel, PowerPoint, Outlook, Visio, etc.

  • Discretion and confidentiality.

  • Agile, with high learning velocity.

  • Demonstrated fluency in organizational agility: knowledgeable how about organizations work and how to get things done through formal and informal channels.

  • Practical familiarity with legal requirements relating to assigned compliance program, or for new hires, practical familiarity with analogous legal requirements.

  • Demonstrated mastery of at least four Compliance functions , to include the core competencies: risk assessments, training, policies and procedures, monitoring, auditing, external audit coordination, control assessments, reporting, corrective actions, implementation oversight, and ability to perform those compliance functions effectively within that compliance program; or if assigned to a specialized function (e.g. FDR/ DDE Compliance, Marketing Materials Review, Data Validations), mastery of all competencies related to that specialized function.

  • Demonstrated ability to handle successfully the most complex, most difficult matters end-to-end.

  • Demonstrated ability to drive success with the most challenging and/or most elevated partners.

Additional Minimum Requirements (Compliance Analyst III)

  • Demonstrated mastery of legal requirements relating to assigned compliance program; or for new hires, demonstrated mastery of analogous legal requirements.

  • Demonstrated mastery of at least 6 core compliance functions, including the core competencies and ability to deftly perform all compliance functions relating to assigned compliance program as needed.

  • Demonstrated excellence in building effective relationships at all levels of the organization; influencing decision-making; effectively framing issues and dialogues; and driving successful outcomes.

  • Demonstrated, end-to-end operational knowledge relating to assigned compliance program.

  • Demonstrated peer mentoring and departmental leadership.

Normally to be proficient in the competencies listed above

Compliance Specialist II would have a Bachelor's degree or equivalent experience; 5 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment preferred.

Compliance Specialist III would have at least a Bachelor's degree or equivalent experience; 8 years of compliance experience or equivalent related experience, with experience in a health care or Medicare-regulated environment or ACA-regulated environment preferred.

Work Environment

  • Travel rarely required, locally or out of state.
  • May be required to work outside normal hours.

  • Medicare Compliance Analyst II or III

    3 days ago

    Portland, United States Cambia Health Solutions, Inc Full time

    Compliance Analyst II or IIIWork Remotely from Oregon, Washington, Idaho or UtahPrimary Job PurposeAs a member of the Compliance team, the Compliance Analyst is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state, federal and...

  • General Compliance Analyst II or III

    3 days ago

    Portland, United States Cambia Health Solutions, Inc Full time

    General Compliance Analyst II/IIIWork Remotely from Oregon, Washington, Idaho or UtahPrimary Job PurposeAs a member of the Compliance team, the Compliance Analyst II/III is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state,...

  • General Compliance Regulatory Consultant

    3 weeks ago

    Portland, United States Cambia Health Solutions, Inc Full time

    General Compliance Analyst II/IIIWork Remotely from Oregon, Washington, Idaho or UtahPrimary Job PurposeAs a member of the Compliance team, the Compliance Analyst II/III is responsible to deliver an effective compliance program. They design, implement, deliver, measure and refine activities and controls to prevent, detect and correct violations of state,...

  • Benefit Specialist II or III, DOE

    3 days ago

    Portland, United States Cambia Health Solutions, Inc Full time

    Benefit Specialist II or III, DOERemote opportunity for residents of Oregon, Washington, Idaho and Utah Primary Job PurposeThe Benefit Development Specialist II utilizes knowledge of current and proposed healthcare regulations and potential benefit offerings to analyze, develop, implement and monitor new or existing benefits in order to ensure benefit...

  • Benefit Specialist II or III, DOE

    3 weeks ago

    Portland, United States Cambia Health Solutions Full time

    Benefit Specialist II or III, DOE Remote opportunity for residents of Oregon, Washington, Idaho and Utah Primary Job Purpose The Benefit Development Specialist II utilizes knowledge of current and proposed healthcare regulations and potential benefit offerings to analyze, develop, implement and monitor new or existing benefits in order to ensure benefit...

  • Benefit Specialist II or III, DOE

    3 weeks ago

    Portland, United States Cambia Health Solutions, Inc Full time

    Benefit Specialist II or III, DOERemote opportunity for residents of Oregon, Washington, Idaho and Utah Primary Job PurposeThe Benefit Development Specialist II utilizes knowledge of current and proposed healthcare regulations and potential benefit offerings to analyze, develop, implement and monitor new or existing benefits in order to ensure benefit...

  • Program Analyst

    4 weeks ago

    Portland, United States Bonneville Power Administration Full time

    Summary This position is located with Bonneville Power Administration, in the Environmental Planning and Analysis (EC) organization of Environment, Fish, and Wildlife (E), Bonneville Power Administration (BPA). A successful candidate in the Program Analyst (Environmental Compliance) position will support BPA's National Environmental Policy Act (NEPA)...

  • Business Systems Analyst II

    5 days ago

    Portland, United States CorVel Full time

    Business Systems Analyst II - Customer Acceptance Testing Job Category : General & Administrative (Corporate) Requisition Number : BUSIN008398 Apply now Posted : April 25, 2024 Full-Time Locations Showing 1 location Portland, OR 97201, USA Description CorVel Corporation is hiring a Business Systems Analyst to coordinate customer integrations and to drive...

  • Product Implementation Mgr

    3 weeks ago

    Portland, United States Cambia Health Solutions, Inc Full time

    PRODUCT IMPLEMENTATION MANAGER (I or II) (HEALTHCARE)Telecommute thru Onsite Options - Must reside in ID, OR, UT or WAWHO WE NEEDThe Product Implementation Manager (I or II) ensures that new Medicare Advantage products and product enhancements are implemented and delivered to the market timely, in compliance with Centers of Medicare and Medicaid Services...

  • Lead Ed Tech III

    4 weeks ago

    Portland, United States Facility Maine Behavioral Healthcare Full time

    Summary The Lead Education Technician III provides academic instruction and behavioral support in our year-round special purpose schools. Under the supervision of the Special Education Teacher and the Director, the Lead Ed Tech III also carries additional classroom and administrative responsibilities and provides support for the Ed Techs throughout...

  • Counselor III

    1 month ago

    Portland, Oregon, United States Cascadia Health Full time

    Cascadia Health (), one of the largest community behavioral health providers in the state of Oregon, delivers whole health care -- integrated mental health and addiction services, primary care and housing -- to support our communities. Our approach is recovery-oriented and trauma-informed. Cascadia hires innovative, compassionate, and dedicated staff who are...

  • Business Operations Analyst III

    7 days ago

    Portland, United States DISH Network L.L.C Full time

    DISH, an EchoStar Company, has been reimagining the future of connectivity for more than 40 years. Our business reach spans satellite television service, live-streaming and on-demand programming, smart home installation services, mobile plans and pro Operations Analyst, Business Operations, Business, Operations, Analyst, Skills, Manufacturing

  • Program Manager III

    4 weeks ago

    Portland, Oregon, United States Cascadia Health Full time

    Cascadia Health (), one of the largest community behavioral health providers in the state of Oregon, delivers whole health care -- integrated mental health and addiction services, primary care and housing -- to support our communities. Our approach is recovery-oriented and trauma-informed. Cascadia hires innovative, compassionate, and dedicated staff who are...

  • Corporate Compliance Analyst, FERC

    2 days ago

    Portland, Oregon, United States Portland General Electric Company Full time

    Key ResponsibilitiesCompliance Program Management: Supporting the administration of FERC compliance policies, programs, and standards. Identifying programs and initiatives to ensure all corporate systems are compliant and incorporating new regulatory requirements.Controls Framework Assessment: Identifying compliance controls, recommending monitoring plans,...

  • Corporate Compliance Analyst, FERC

    4 weeks ago

    Portland, Oregon, United States Portland General Electric Company Full time

    Key Responsibilities Compliance Program Management Supports administering FERC compliance policies, programs and standards. Under supervision, identifies programs and initiatives to ensure all corporate systems are compliant and to incorporate new applicable regulatory requirements.Controls Framework Assessment Under supervision, identifies compliance...

  • Corporate Compliance Analyst, FERC

    1 month ago

    Portland, United States Portland General Electric Company Full time

    Key Responsibilities Compliance Program Management Supports administering FERC compliance policies, programs and standards. Under supervision, identifies programs and initiatives to ensure all corporate systems are compliant and to incorporate new applicable regulatory requirements. Controls Framework Assessment Under supervision, identifies...

  • Mobile Counselor III

    4 weeks ago

    Portland, Oregon, United States Cascadia Health Full time

    Cascadia Health (), one of the largest community behavioral health providers in the state of Oregon, delivers whole health care -- integrated mental health and addiction services, primary care and housing -- to support our communities. Our approach is recovery-oriented and trauma-informed. Cascadia hires innovative, compassionate, and dedicated staff who are...

  • Provider Relations Specialist II

    18 hours ago

    Portland, United States CorVel Healthcare Corporation Full time

    Job Description Job Description Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent,...

  • Program Analyst

    4 weeks ago

    Portland, United States Bonneville Power Administration Full time

    Summary This position is located with Bonneville Power Administration, in the Business Operations Support (EWB) organization, Fish and Wildlife Program (EW), Environment, Fish and Wildlife (EW), Bonneville Power Administration (BPA). A successful candidate in the Program Analyst position will serve as the Lead for the EWB Invoice Team and reports...

  • Provider Relations Specialist II

    3 days ago

    Portland, United States CorVel Healthcare Corporation Full time

    Job Description Job Description Assists providers via phone and email with basic to complex bill review questions and requests. Documents bill review errors for tracking and trending to improve team error rate. Acts as a positive and professional representative of our CorVel family; ensures compliance with company best practice standards; ensure consistent,...