Jobs in Chula Vista, CA
Last updated: 11 days ago)
We have an opportunity to join the Alliance as a Program Integrity Specialist II in the Compliance Department.WHAT YOU'LL BE RESPONSIBLE FOR.
Reporting to the Program Integrity Manager, this pos...Show moreLast updated: 12 days ago
At Aarris Homecare, we understand that our caregivers are our best asset and we care about the work that you do.If you’re passionate and committed to client well-being and are looking for a w...Show moreLast updated: 30+ days ago
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...Show moreLast updated: 30+ days ago
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...Show moreLast updated: 30+ days ago
We’re looking for Customer Support Product Testers across the US to work from home and help top brands improve their products before they hit the market.Show moreLast updated: 30+ days ago
A reasonable salary range estimate for this position is $68,247 -$89,047.The posted UC academic salary scales (https : / / www.
See the following table for the salary scale for this position.Sunday, Apr...Show moreLast updated: 30+ days ago
I am a 30 year old female, single, and I am new to San Diego! I will be moving down there in July to start grad school at Scripps Institution of Oceanography for a Climate Science and Policy progra...Show moreLast updated: 11 days ago
Are you looking for flexible hours? You could earn money working from home in your spare time.MySurveyCenters can help you earn up to.
Surveys for some of the nation’s top brands.Up to $400 pe...Show moreLast updated: 30+ days ago
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Program Integrity Specialist II
Central California Alliance for Health (Remote)San Diego, CA, US12 days ago
Job type
- Full-time
Job descriptionHas experience working in a managed care or healthcare environment Is knowledgeable of HIPAA regulations and committed to maintaining data privacy and security Is proficient in Microsoft Office, especially Word and Excel Has an acute attention to detail and data accuracy Has experience working remotely and knows how to self-motivate while staying closely connected to their team Has excellent multitasking skills and the ability to manage multiple projects at once in a deadline-driven environment Has knowledge of the Medi-Cal and Medicare Advantage programs and related regulations Knowledge of : Research, analysis, and reporting methods General health care compliance and privacy principles, quality improvement practices, and related audit techniques Proficiency with Windows-based PC systems and Microsoft Word, Outlook, PowerPoint and Excel (including pivot tables), and Adobe Acrobat Ability to : Conduct thorough investigations and produce well-documented and accurate conclusions and recommendations Develop, implement, and monitor corrective action plans with guidance from the Program Integrity Specialist III or Program Integrity Manager Understand and interpret provider contracts and provider payment system processes Identify and research relevant legal materials, analyze and interpret legal and contractual language Education and Experience : We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more
Job Description
Job Description
We have an opportunity to join the Alliance as a Program Integrity Specialist II in the Compliance Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Program Integrity Manager, this position :
- Conducts medium- to high-complexity investigations into alleged fraud, waste and abuse (FWA) referred to or identified by the Alliance FWA Prevention (FWAP) Program and / or Special Investigations Unit (SIU)
- Assists with the administration of medium- to high-complexity Program Integrity activities
- Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities
- Performs other duties as assigned
ABOUT THE TEAM
The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization's integrity and members access to quality healthcare. We are the team that helps employees understand and follow the complex rules and requirements to meet our important compliance obligations. In short, we define and support the Alliance's Culture of Compliance internally and with our external healthcare partners. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities.
THE IDEAL CANDIDATE
WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description and list of requirements, click here
Quickly understand Alliance functions and roles and responsibilities related to oversight agencies and learn and apply policies, procedures, and guidelines, including Medi-Cal and Medicare guidelines
Bachelor's degree in Healthcare Administration, Public Health Administration, Criminal Justice, Finance, or a related field and a minimum of three years of program integrity, auditing, quality improvement, or compliance-related experience in the healthcare industry (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying.
OTHER INFORMATION
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Typical areas in Zone 1 : Bay Area, Sacramento, Los Angeles area, San Diego area
Typical areas in Zone 2 : Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area
Zone 1 (Monterey, San Benito and Santa Cruz)
69,937—$111,904 USD
Zone 2 (Mariposa and Merced)
63,645—$101,837 USD
OUR BENEFITS
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet .
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.