Compliance Specialist

Job Title: Compliance SpecialistStart Date: ASAPDuration: Full-Time EmploymentWork Hours: Full-time, 40 hours/weekLocation: Portland, OR (Hybrid, 2 days in office); Open to candidates in OR/WA with frequent access to the officeEquipment & Access: Equipment and access provided upon startAbout 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.

Created: 2025-02-19