Description
The Compliance Advisor ensures that company marketing and member communication services are compliant with all Medi-Cal, federal and state regulations, as well as with contractual provisions. This is achieved by participating in the Plan Partner annual audits and through continuous oversight of marketing activities and member materials, as well as other related managed care services activities.In addition, the Compliance Advisor will collaborate with staff to correct identifying performance deficiencies, and help mitigate risk by identifying areas of needed improvement. The Compliance Advisor will also ensure that the company and its Partners are compliant with member communications, use of corporate logo, trade name and affiliation statement, annual mailing to Medi-Cal members, marketing staff training, marketing staff monitoring and marketing events and member outreach activities prescribed by state, federal and contractual requirements.
Finally, the Compliance Advisor will serve as a resource to internal staff on compliance matters within his/her subject matter expertise, will perform internal audits and/or investigations as needed or required, and will collaborate/participate in workgroups, activities, or special projects, as required and assigned.
SKILLS:
EXPERIENCE Required:
- Four (4) years in a managed care setting. Working knowledge of Medi-Cal Managed Care Principles
- Highly developed analytical, project management and audit skills required.
- Also required, excellent writing, verbal, communication and presentation skills.
- The Compliance Advisor must be able to work independently as well as in cross-functional/cross-departmental teams.
- Working knowledge of DHCS and DMHC requirements and Medi-Cal and Medicare regulations are preferred.
- Bachelor's degree in Business Administration, Communications, Marketing or Health Care Management or related field.
- Master's degree in Healthcare, business management or related field.