Medicaid Compliance Consultant IV

Kaiser Permanente

Portland, OR

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JOB DETAILS

SKILLS

Analysis Skills, Business Support, Consulting, Corporate Compliance, Corrective Action, Cross-Functional, Detail Oriented, Diversity, Documentation, Federal Laws and Regulations, Financial Audit, Financial Regulations, Forecasting, Functional Analysis, Health Plan, Healthcare, Healthcare Administration, Healthcare Quality, Information/Data Security (InfoSec), Insurance, Leadership, Legal, Maintain Compliance, Medicaid, Metrics, Monitor Regulations, Negotiation Skills, Operations Planning, Performance Analysis, Policy Development, Problem Solving Skills, Procedure Development, Project Evaluation, Project Planning, Project Schedule, Project/Program Coordination, Project/Program Management, Public Health, Public Policy, Qualitative Analysis, Quantitative Analysis, Regulations, Regulatory Compliance, Regulatory Requirements, Reporting Skills, Risk, Risk Analysis, Staff Training, State Laws and Regulations, Strategic Planning, Team Player, Time Management, Training/Teaching

LOCATION

Portland, OR

POSTED

10 days ago

The Compliance Consultant IV will maintain and enhance the Medicaid Compliance Program of KP Northwest Region and partner closely with the KP Northwest Medicaid Department to advise regional staff on contractual and regulatory Medicaid requirements in Oregon and Washington; develop functional procedures compliant with state Medicaid program requirements; monitor performance against Medicaid compliance metrics; conduct annual risk assessment; and conduct education and training of personnel on compliance issues, as needed. The Medicaid Compliance Program Manager plays a key role by providing subject matter expertise and support for all regional program audit activity and works with the Medicaid Operations Team and other internal business partners to develop corrective actions in response to audit findings. Job Summary: This individual contributor is primarily responsible for conducting company compliance activities in collaboration with internal and external stakeholders. Responsibilities include developing compliance reports, conducting compliance investigations, coordinating implementation of compliance efforts, and assisting with regulatory compliance through monitoring regulatory changes. This individual contributor also assists with and supports management of projects including assisting in development and coordination of plans and coordinating with stakeholders. Essential Responsibilities: + Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and develop weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback. + Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities. + Conducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities. + Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings. + Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations. + Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts. + Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes. + Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence. Knowledge, Skills and Abilities: (Core) + Ambiguity/Uncertainty Management + Attention to Detail + Business Knowledge + Communication + Critical Thinking + Cross-Group Collaboration + Decision Making + Dependability + Diversity, Equity, and Inclusion Support + Drives Results + Facilitation Skills + Health Care Industry + Influencing Others + Integrity + Learning Agility + Organizational Savvy + Problem Solving + Short- and Long-term Learning & Recall + Teamwork + Topic-Specific Communication Knowledge, Skills and Abilities: (Functional) + Analytical Skills + Compliance Management + Cross Department Coordination + Getting Work Done Through Others + Negotiation + Project Management + Technical Communication + Written Communication Minimum Qualifications: + Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement. Preferred Qualifications: + Four (4) years experience in health plan compliance. + Four (4) years experience in health plan operations. + Three (3) years experience working cross-functionally across departments, functions, or business lines. + Three (3) years health care experience. + Two (2) years project management experience. + Two (2) years experience in a leadership role with or without direct reports. + Master's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field. + Certified in Healthcare Compliance (CHC) or other equivalent compliance certification. COMPANY: KAISER TITLE: Medicaid Compliance Consultant IV LOCATION: Portland, Oregon REQNUMBER: 1429344 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

About the Company

Kaiser Permanente

At Kaiser Permanente, we are relentless in our pursuit of excellence. Driven by our mission to provide the highest quality preventive medicine, we are committed to eliminating health care disparities, and to making lives better through innovation, technology, and research. Our desire to deliver the best possible care inspires us to promote wellness among our members, communities, and each other. It also fuels our belief that everyone — regardless of circumstance — deserves access to affordable care, which further drives our motivation to expand our reach. Founded nearly 80 years ago, our unique business model sets us apart — positioning us to drive improvements across the industry and around the world.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Healthcare Services

FOUNDED

1945

WEBSITE

http://www.kp.org/careers