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Bay Area Community Health

Compliance Manager (49541)

Posted 6 Days Ago
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In-Office
94538, Fremont, CA, USA
106K-123K Annually
Senior level
In-Office
94538, Fremont, CA, USA
106K-123K Annually
Senior level
Ensure organizational compliance with federal and state regulations, manage claims (including FTCA and medical malpractice), develop and implement policies, design control systems and training, perform audits and monitoring, advise senior leadership on risk and policy, coordinate regulatory exam responses, review marketing and materials for compliance, and supervise compliance specialists.
The summary above was generated by AI

Overall Summary:

Compliance Manager is responsible for ensuring policies and procedures comply with regulatory and ethical standards of the organizations comply accreditation standards by implementing and administering practices, programs and policies. Compliance Manager is to ensure everyone adheres to legal standards and in-house policies.  Perform regular audits; implement policies, design control systems and business procedures and processes to ensure compliance. Compliance Manager oversees the claims management process and processing of claims-related activities under FTCA and serves as the claims point of contact as a part of the daily job duties.

 

Essential Responsibilities:

  • Develop and maintain the claims management process for addressing any potential or actual health or health-related claims including medical malpractice claims, which may be eligible for FTCA coverage.
  • Oversee the claims management process and processing of claims-related activities under FTCA and serve as the claims point of contact.
  • Analyze internal business systems to ensure compliance with industry regulations and ethical standards.
  • Create, modify, update and implement policies.
  • Develop risk management strategies.
  • Design control systems to address cases of violation of internal business policies.
  • Design ongoing training programs for employees of the organization.
  • Liaise with Sr. Leadership and management team to ensure that all business operations are in line with the organizational policies.
  • Advise Sr. Leadership on business operations relating to investment, risks and any other policy development.
  • Participates in the review and recommendation of department policies and procedures to ensure operations are compliant with applicable laws and regulations. When requested, assists staff with job aids and forms.
  • Monitoring and Testing - Leads compliance reviews and documents and supports compliance findings. Drafts compliance reports and communicates findings to management.
  • Conducts initial reviews of alleged compliance violations and escalates to management as needed.
  • Monitors and tracks applicable federal and state laws and regulatory guidelines and regulations applicable to the organization.
  • Identifies impacted business units and coordinates with business teams to implement necessary operational or policy changes in response to regulatory change.
  • Supports product development and process change management by participating in meetings with project teams to ensure compliance with regulations and internal policies and procedures, as applicable.
  • Independently tracks and records changes to federal regulation and works with organization to determine impact to processes and operations.
  • Independently researches laws and regulations impacting the organization.
  • Regularly responds to staff regarding questions on compliance issues with appropriate, risk-based, and properly supported guidance.
  • Identifies training needs of organization and recommends training subjects to Compliance and/or Learning & Development.
  • Reviews marketing forms, advertisements, disclosures, website and other materials for compliance.
  • Aids the Director of Compliance in reviewing and analyzing regulatory proposals issued for comment by various regulatory agencies.
  • Experience with regulatory examiners (responding to regulatory requests, producing documents and/or leading exams).

 

Secondary Responsibilities:

  • Performs other duties that may be required and assigned by the supervisor.
  • Must have strong PC skills. Excellent oral and written communication skills.
  • Must effectively communicate regulatory rules and requirements to supported business units. Communicates accurate and timely information to key stakeholders, and models professionalism, openness and respect.
  • Must have good problem-solving skills and the ability to work independently.
  • Handles moderately complex issues and problems and refers more complex issues to higher-level staff.
  • Demonstrates in-depth knowledge and expertise of applicable lending laws and regulations, including knowledge of key industry resources, to ensure sound guidance is provided.
  • Develops and builds functional expertise in processes.
  • Self-starter, organized, analytical, detail oriented.
  • Attends workshops, training, and meetings as needed, and as requested.
Qualifications

Qualifications:

  • Four-year college degree or equivalent.
  • Significant experience in researching and interpreting laws and regulations
  • Compliance certification from a recognized trade organization (e.g., CUCE, NCCO, CRCM) preferred, but not required.
Physical Demands:

This position requires:

  • Sitting, walking, and standing associated with a normal medical, clinical and administrative office environment, with some bending, reaching, stretching, and lifting up to 25 pounds.
  • Manual dexterity for tasks involving standard office equipment and computer keyboard, including repetitive movements, such as typing.
  • Traveling to work sites, including some exposure to outside elements.
  • Exposure to potentially dangerous materials and situations, requiring adherence to extensive safety precautions and possibly the use of protective equipment.

Confidential Employee:

A confidential employee is someone who helps formulate management policies regarding worker conditions and has access to confidential information that helps formulate those labor policies. Some possible examples of confidential employee job titles are: secretaries, assistants to supervisors or managers, and anyone in labor relations departments or HR. If a worker is typically in management meetings, but not a manager themselves, they may well be a confidential employee.  These are personnel who assist and act in a confidential capacity to management personnel, or as someone who has regular access to confidential information re: bargaining strategy or changes the employer anticipates may result from the collective bargaining process.

Supervises:

  • Compliance Specialist I
  • Compliance Specialist II

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