Salary : $163,440.16 - $199,295.20 Annually
Location : Throughout the County of Santa Clara, CA
Job Type: Full-Time
Job Number: 24-C41-B
Department: Valley Health Plan
Opening Date: 06/11/2024
Closing Date: 7/24/2024 11:59 PM Pacific
Bargaining Unit: 92
Description
Under general direction, to coordinate planning, development, implementation, and monitoring of an effective compliance and patient privacy program for the Santa Clara Valley Healthcare.
Managed Care Plan:
One position would be for the Valley Health Plan (VHP) Compliance Officer role. This candidate will be in charge of overseeing VHP's compliance with the various managed care regulations, regulatory filings, delegation and pre-delegation audits, fraud, waste and abuse audits, etc. This position reports to the Chief Compliance Officer - Health System.
Typical Tasks
The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.

• Implements system-wide programs, policies, and procedures to ensure compliance with applicable federal and state laws and regulations, such those related to Medicare, Medi-Cal, managed care, commercial insurance, federal and state contracts and grants, and other applicable programs and funding sources;

• Implements a system-wide patient privacy program by working closely with department leaders to ensure compliance with federal, state, and contract privacy laws and regulations, such as the Health Insurance Portability and Accountability Act, California Confidentiality of Medical Information Act, Lanterman Petris Short Act, 42 C.F.R. Part 2, etc.;

• Directs activities for system-wide audits to investigate and monitor healthcare privacy, healthcare billing, and contract compliance with standards and procedures required by federal and state laws, including supervising the audit activities conducted by contracted consultants;

• Develops, writes, and implements a code of conduct, policies, and procedures that establish standards for an organizational culture of compliance, privacy, and ethics, giving specific guidance to management, medical staff, and individual departments or employees, as appropriate;

• Develops, implements, and provides orientation and ongoing educational programs via various communication platforms designed to specifically promote an understanding of compliance and privacy issues, laws, and regulations and the consequences of non-compliance throughout the County of Santa Clara Health System (CSCHS);

• Maintains an awareness of compliance and privacy laws and regulations, keeping abreast of current changes that may affect healthcare systems through personal research, seminars, and peer contact;

• Reviews and leads inquiries concerning billing and reports of noncompliance; reviews results of documentation compliance audits;

• Participates in appropriate response, develops corrective action plans, and oversees compliance and privacy investigations, including maintaining the confidentiality of information reported by individuals in order to protect both the individual and the subject of the investigation;

• Provides analysis of data sharing projects, including mapping data flows, analyzing data elements, interpreting federal and state privacy laws, and collaborating with the Information Security Office to ensure secure and appropriate release and storage of the Health System's patient health information;

• Implements and maintains a system for encouraging staff to report non-compliance and potential fraud, waste, and abuse without fear of retaliation;

• Reviews complaints, concerns, or questions relative to compliance issues and provides consultative leadership and support to all entities as appropriate;

• Ensures that internal controls throughout the system are sufficient to provide for accurate, complete, and compliant programs and processes;

• Serves as a subject matter expert on relevant technology projects, providing expertise and guidance on the identification and mitigation of compliance and privacy risks, including potential False Claims Act violations, inaccurate documentation and billing, and breaches of federal and state privacy law;

• Serves as the main point of contact for state and federal agencies conducting external audits and compliance and privacy investigations and leads the organization to ensure appropriate and timely responses;

• Develops corrective action plans and oversees investigations, including maintaining the confidentiality of the investigation;

• Organizes and leads Compliance Committees for the Health System Departments, including Hospitals and Clinics, Behavioral Health Services, Valley Health Plan, Custody Health, Public Health, and Emergency Medical Services, as well as represents Compliance on other County and Health System committees;

• Prepares regular and timely reports to the Chief Compliance Officer, County Health System Leadership, and Compliance Committees on compliance and privacy issues and activities, including major findings, problems, and violations, and recommends remedial correction and prevention actions;

• Promotes awareness and understanding of positive ethical and moral principles consistent with the mission, vision, and values of the organization and those required by federal and state law;

• Interacts with all levels of management throughout the County of Santa Clara Health System;

• Establishes guidelines and procedures for ongoing compliance review to identify risks and deficiencies, develop annual work plans, and recommend corrective action plans;

• Supervises subordinate staff, including Program Managers and Compliance analysts;

• May be assigned as a Disaster Service Worker (DSW), as required;*

• Performs other related duties, as required.

Employment Standards
Sufficient education, training, and experience to demonstrate the ability to perform the above tasks, plus the possession and direct application of the following knowledge and abilities:
Training and Experience Note : The required knowledge and abilities are attained through possession of a Bachelor's degree, preferably in healthcare administration, finance, accounting, auditing, and/or a related field
AND
Five (5) years of professional level compliance and/or financial management experience, at least two (2) years of which must be in a hospital setting.
Special Requirements

• Ability to travel to alternate locations in the course of work. If driving, possession of a valid California driver's license prior to appointment and the ability to qualify for and maintain a County driver authorization.

• *As a condition of employment, pursuant to California Government Code Sections 3100-3109 and Local Ordinance, all County of Santa Clara employees are designated Disaster Service Workers (DSWs), including extra help. A DSW is required to complete all assigned DSW related training, and in the event of an emergency, return to work as ordered.

Knowledge of:

• Federal and state healthcare laws, regulations, and requirements for third-party billing (especially Medicare, Medi-Cal, and managed care);

• Basic principles of hospital organization and administration;

• Regulations and laws common to the operation of hospitals in California;

• Accounting and auditing methods applicable to hospital and clinic operations;

• Third-party audit reviews and risk assessments;

• Planning and problem-solving methods;

• Principles of supervision;

• English usage, style, grammar, punctuation, and spelling;

• Common computer systems and applications;

Ability to:

• Administer, coordinate, and supervise the compliance program of a large, modern healthcare organization;

• Keep abreast of current Medicare, Medi-Cal, and managed care regulations;

• Explain and interpret compliance and privacy issues to other officials;

• Identify compliance and privacy problems and devise procedural changes to resolve them;

• Learn and apply the County of Santa Clara Health System's policies, regulations, and administrative procedures in the context of the compliance program;

• Communicate effectively, both orally and in writing, with people of diverse backgrounds and cultures;

• Establish and maintain effective working relationships with those contacted in the course of work, at all levels, including colleagues, the public, and representatives of other agencies;

• Work effectively as a member of a management team in a healthcare organization.

The County offers comprehensive first-class medical, dental, and vision benefits plans for County employees and their dependents, including plans with no deductibles, no co-pays, no co-insurance, and no prescription drug co-pays. Learn more
The County also offers generous paid time off with significant vacation, sick time, and 13 paid County holidays annually! Details are included in the with the bargaining unit applicable to the job classification.
In addition to the amazing perks above, the County also offers the additional benefits below.
Retirement Benefits
The County offers robust retirement plans including a (similar to the private sector's 401(k) plan) and the In addition to lifetime retirement income available through the CalPERS pension plan, the 457(b) Deferred Compensation plan provides a great way to save for retirement and supplement the defined benefit pension available to employees. These plans help our employees build a plan for their future and contribute to their family's long-term financial well-being.
Health Flexible Spending Account
The empowers employees to manage healthcare expenses efficiently with tax-free contributions (up to $3,200 for the 2024 calendar year). Secure tax-free solutions for your healthcare expenses and enjoy the flexibility to manage your healthcare finances effectively with the HFSA.
Dependent Care Assistance Program (DCAP)
The enables employees to utilize tax-free funds for dependent care services, facilitating a convenient and cost-effective approach for managing your dependent care expenses. The County also offers the , an employer-funded DCAP, for employees with annual income under $120,000.
Life and AD&D
The County offers life and disability benefits including , Insurance, These benefits ensure financial security and income support when you and your family need it most.
Employee Assistance Program (EAP)
The County prioritizes employee mental health and well-being and offers a top-tier through Concern providing confidential counseling sessions covering stress, anxiety, relationships, grief, as well as financial/legal services, personal coaching, child and elder care referrals, and comprehensive crisis support.
Employee Wellness
The offers free wellness programing, fitness classes and resources; including Elevate My Wellness an all-in-one platform designed to elevate your well-being journey.
Education Reimbursement
A generous program is available, including Education Reimbursement for employees seeking additional training and professional development.
NOTE : Benefit and Retirement information may vary from bargaining unit to bargaining unit. Due to changes in State Law, current pension provisions described in the union contracts are not automatically applied. Specific pension benefits for new hires who start on or after January 1, 2013 may be different than indicated in the union contracts.
Click here to access all Memoranda of Understanding and most recent Summary of Changes.
01

Please answer the following questions. Completion of the following supplemental questions is REQUIRED for your application and is an integral part of the evaluation process. Initially, it will be used to evaluate against the employment standards. For those applicants meeting the employment standards, this information will be critical in the subsequent competitive assessment to identify those candidates to be invited to continue in the examination process. Your responses to the questions may also be reviewed and scored in a Competitive Rating evaluation process based on pre-determined rating criteria. Your answers should be as complete as possible, as no additional information will be accepted from applicants once the Competitive Rating evaluation has begun. Please include the name of employer, job title, dates of employment and number of hours worked per week for questions asking about your experience. A response of "see resume" or "see application" will deem your application incomplete. Vague, incomplete or non-responsive answers could result in no or low scores in a competitive rating process. Do you understand this requirement?

• Yes
• No

02

What is the highest level of education you have completed?

• None
• High School or GED equivalent
• College (1 to 29 semester units / 1 to 44 quarter units)
• College (30 to 59 semester units / 45 to 89 quarter units)
• College (60 to 89 semester units / 90 to 134 quarter units)
• College (90 to 119 semester units / 135 to 179 quarter units)
• College (120 or more semester units / 180 or more quarter units)
• Associate's Degree
• Bachelor's Degree
• Master's Degree
• Doctoral Degree

03

Do you have a BA or higher in any of the following?

• Healthcare Administration
• Finance
• Accounting
• Auditing
• Other Related Field
• None of the above

04

Please list the name of all degrees, the level, and where it was obtained. If you do not have any write "none."
05

How many years of professional level compliance management experience do you have?

• None
• Less than one year
• One to less than two years
• Two to less than three years
• Three to less than four years
• Four to less than five years
• Five to less than six years
• Six to less than seven years
• Seven to less than eight years
• Eight to less than nine years
• Nine to less than ten years
• Ten years or more

06

Describe your professional level compliance management experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
07

How many years of professional level financial management experience do you have?

• None
• Less than one year
• One to less than two years
• Two to less than three years
• Three to less than four years
• Four to less than five years
• Five to less than six years
• Six to less than seven years
• Seven to less than eight years
• Eight to less than nine years
• Nine to less than ten years
• Ten years or more

08

Describe your professional level financial management experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
09

How many years of professional level compliance and/or financial management experience do you have in a managed care setting?

• None
• Less than one year
• One to less than two years
• Two to less than three years
• Three to less than four years
• Four to less than five years
• Five or more years

10

Describe your professional level compliance and/or financial management experience in a managed care plan.Please include the name of the employer, name of hospital, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
11

Do you have the following knowledge or experience? (Select all that apply)

• Centers for Medicare and Medicaid Services (CMS)
• Medi-Cal
• Medi-Cal managed care requirements
• California Department of Managed Health Care
• Private insurance billing requirements
• Fraud, waste, and abuse auditing
• Privacy investigation
• Third-party reviews and risk assessments
• Other related knowledge or experience
• None of the above

12

For each of the options selected in the previous question, please provide examples of knowledge application and/or experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
13

How many years of professional work experience do you have planning and problem solving compliance and privacy issues?

• None
• Less than one year
• One to less than two years
• Two to less than three years
• Three to less than four years
• Four to less than five years
• Five or more years

14

Provide an example of a time you used planning and problem solving to address a compliance and privacy issue.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
15

Do you have professional supervisory experience?

• Yes
• No

16

How many years of experience do you have administering, implementing, and monitoring a compliance program?

• None
• Less than one year
• One to less than two years
• Two to less than three years
• Three to less than four years
• Four to less than five years
• Five or more years

17

Describe your professional supervisory experience. Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".For each relevant position held, please provide specific information that clearly describes:(a) Your functional areas of responsibility.(b) The size and type of each organization.(c) Your position within each organization and the title of the position to which you report(ed).(d) The number and level of staff supervised.(e) How you effectively motivated and managed your team.
18

Describe your experience administering, implementing, and monitoring a compliance program.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
19

Do you have experience working with the following staff? (Select all that apply)

• Executives
• Senior Leaders
• Middle Managers
• Line Staff
• Other Related Staff
• None of the above

20

Describe your experience communicating with various levels of staff to explain compliance and privacy matters.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N/A".
21

How did you find out about this job?

• Contacted by County Recruiter
• Contacted by a Recruitment Firm
• County Employee Referral
• County of Santa Clara Career Website
• County of Santa Clara Job Interests Email Notification
• Facebook
• Instagram
• LinkedIn
• Indeed
• Virtual Job Fair
• In Person Job Fair
• In-Person Networking Professional Event
• Virtual Networking Event
• Community Event
• Glassdoor
• Governmentjobs.com
• Professional Association
• Search Engine (Google, Bing, online search, etc.)
• Hospital Website: SCVMC, O'Connor Hospital, St. Louise Regional Hospital Website
• Handshake
• Student Career Center
• County Text Message
• Other (Specify in the next question)

22

If you selected an event/fair or other in the question above, please specify. If not, type N/A.
Required Question