A Healthcare Administrator directs and coordinates delivery of health care and medical services. Manages finances and recordkeeping and communications with medical staff. Works to improve quality and efficiency. May run smaller medical practices or work in specialized areas within large hospitals or health care systems.
3-6 Months Temp to Hire role The hourly Pay rate is $22.00/hr on W2 (Monday to Friday 9:00 AM to 6:00 PM Half an hour for Lunch) We are seeking a skilled Compliance Administrator - Health Plan Programs to join our client's team, one of the US's largest Eyemed companies.
GENERALFUNCTION
The Administrator-Compliance (Programs)is responsible for preparing, researching, and completing the regulatory reports, amendment filings, and business partners/carrier reporting requirements. This includes operational processes and programs to assure compliance with various regulatory requirements such as Medicare Advantage (MA), Department of Managed Health Care (DMHC), Department of Insurance(DOI), and Employee Retirement Income Security Act (ERISA), Compares and evaluates possible courses of action and makes recommendations to the Compliance Manager or leadership team. Assists the Compliance Manager in assuring compliance with policies, procedures, and requirements set by state and federal agencies. Modifies policies and procedures as necessary.
MAJORDUTIESANDRESPONSIBILITIES
Thoroughly prepares, researches, and completes DMHC reports and amendment filings, business partners/Carriere porting requirements, and any other requirements set by state and federal agencies. Reviews related regulations and performs analysis to assure all requirements are met and filed within the deadline. Thoroughly and timely tracks reporting deadlines by month and log sall in-process and completed reports. Prepares and/or oversees internal claims and quality management / utilization management audit results and findings in collaboration with the Manager. Compliance, Claims Manager/Team Leader, and Quality Management VP/Team Leader and Clinical Director. Prepares documents to be presented to the Quality Management Committee, Public Policy Committee, Board of Directors, and Management Team. Provides oversight with the compliance work plan and monito ring functions and activities including risk assessment. Assists with the Language Assistance Program (LAP) activities such as staff language fluency assessment, monitoring the enrollee assessment report, Customer Service Department call log, and preparing and mail. Prepares reports, maintains files, and communicates the data & information associated with local, state, and federal regulatory guidelines for the network including thoseset forth by EPA, State EPA, CalEPA, California CUP, and other state and local environmental regulatory agencies. Supports compliance with federal, state, and local environmental laws Ability to work effectively with regulatory agencies is required while communicating with facilities throughout U.S. and Canada regarding permits, inspections, and compliance requirements Maintain general and up to date knowledge off ireprotectionsystemsandassociatedgeneralregulatorycompliancerequirements Acquire approval for environmental compliance related payables and track invoices & check requests Manage Water Discharge Monitoring Reports General knowledgeofSPCCplansandStormwatermanagementplansastheyrelatetoouroperations Familiarity with the Clean Air Act as it relates to our operations Familiarity with EPCRA requirements as they relate to our operations General knowledge of California special wastes as they relate to our ope General understanding of Environmental Management Systems Maintaindocumentfilespertainingtoaudits&observationsofworkforceperformancewithregardtoenvironmentalcompliance Through observation of documents such a reports,permits,∈spectionforms,beabletodetectpotentialenvironmentalcomplianceproblemsofanaccounting,bookkeeping,andclericalnature. Facilitate, arrange, and conduct environmental related training and orientation as needed. Track information on energy and resource-efficient projects & programs. This could include energy conservation programs and future LEED certifications.
