Job Description

Job Title: Compliance Specialist

Start Date: ASAP

Duration: Full-Time Employment

Work Hours: Full-time, 40 hours/week

Location: Portland, OR (Hybrid, 2 days in office); Open to candidates in OR/WA with frequent access to the office

Equipment & Access: Equipment and access provided upon start

About the Organization:

A market leader in creating custom integrated healthcare solutions for health plans and employers. With a strong focus on value-based services and evidence-based treatment options, the organization emphasizes quality, outstanding customer service, and cost-effective healthcare strategies. It is committed to ensuring compliance with healthcare regulations while enhancing member satisfaction and reducing administrative burdens.

Role Overview:

The Compliance Specialist is responsible for overseeing Medicare and HIPAA/Privacy Compliance Programs, fostering a strong organizational culture of compliance, privacy, and risk mitigation. This role ensures adherence to applicable regulations, manages audits and reporting processes, and serves as a collaborative resource for internal and external compliance matters.

Key Responsibilities:

Compliance Program Management:

• Oversee Medicare and HIPAA Privacy Compliance Program, ensuring adherence to current regulations and best practices.
• Develop and implement Medicare and HIPAA/Privacy compliance policies, procedures, and operational guidelines.
• Act as the key contact for regulatory compliance matters internally and externally.
• Conduct routine compliance program assessments and implement necessary adjustments.
• Prepare bi-monthly Medicare Compliance Program reports for board review.

Audit & Reporting:

• Manage Medicare audits, reporting requirements, and data validation audits with accuracy and efficiency.
• Ensure timely and effective completion of Medicare Part C ODR reporting processes.
• Handle Medicare communications and meetings with external stakeholders.

HIPAA & Privacy Compliance:

• Oversee HIPAA/Privacy Program, including policy development, implementation, employee training, and monitoring.
• Investigate incidents and breaches, ensuring compliance with federal and state laws.
• Work with senior management and Compliance Committee to establish privacy governance.
• Collaborate with the Security Officer to align privacy and security initiatives.
• Conduct risk assessments and implement corrective action plans when necessary.

Compliance Investigations & Risk Management:

• Investigate alleged compliance violations and recommend corrective actions.
• Ensure compliance communication channels are monitored and issues are addressed promptly.
• Develop, update, and implement compliance-related policies, tools, and resources.
• Support the executive team in Enterprise Risk Management (ERM), disaster recovery, and business continuity planning.

Policy & Procedure Development:

• Ensure Medicare and HIPAA/Privacy policies align with federal, state, and contractual requirements.
• Monitor regulatory changes and update policies as needed.
• Adhere to all reporting guidelines and filing deadlines.

Additional Responsibilities:

• Attend staff, Policy Committee, and Compliance Committee meetings.
• Assist in other compliance-related duties as assigned.

Required Skills & Qualifications:

• Bachelor’s Degree required.
• Minimum of three years’ experience in a compliance role within healthcare or health plans.
• Preferred experience leading compliance functions in healthcare or Medicare/Medicaid settings.
• Strong knowledge of healthcare laws, standards, and regulations.
• Experience conducting compliance investigations and Medicare Part C ODR reporting.
• Ability to manage sensitive data with confidentiality.
• Strong analytical, problem-solving, and organizational skills.
• Excellent written and verbal communication abilities.
• Ability to collaborate effectively in a team environment while working independently as needed.

This role is ideal for a compliance professional looking to make a significant impact in a healthcare-focused organization. If you are a strategic thinker with a passion for regulatory compliance and risk management, we encourage you to apply.

Job Tags

Similar Jobs