We have an opportunity to join the Alliance as a Program Integrity Specialist in the Compliance department.

 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Compliance Supervisor, you will conduct investigations into alleged fraud, waste and abuse (FWA) referred to or identified by the Alliance FWA Prevention (FWAP) Program and/or Special Investigations Unit (SIU). You will also coordinate Alliance delegate oversight activities to ensure subcontractors' compliance with state, federal and Alliance requirements and assist with the administration of Program Integrity activities. 

 

THE IDEAL CANDIDATE 

  • Strong Microsoft Excel skills, including the ability to create pivot tables, graphs, charts and/or use formulas
  • Detail-oriented, with the ability to also see the big picture and connect larger dots
  • Experience and skill in doing investigative work and/or research 
  • Accountable and solution-focused when problems are identified
  • Enjoys sifting through data and working to find solutions

 

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

  • Knowledge of:
    • Medi-Cal guidelines
    • Research, analysis, and reporting methods
    • Health care regulatory processes
    • Principles of health care planning and administration
    • Compliance, quality improvement practices, and related audit techniques
  • Ability to:
    • Quickly understand Alliance functions and  roles and responsibilities related to oversight agencies and learn and apply policies, procedures and guidelines, including Medi-Cal guidelines
    • Conduct thorough investigations and produce accurate conclusions and recommendations
    • Understand and interpret provider contracts and provider payment system processes
    • Demonstrate strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
    • Identify and research relevant legal materials and analyze and interpret legal and contractual language
    • Be proactive and demonstrate resourcefulness
  • Education and Experience:
    • Bachelor’s degree in Finance, Accounting, Public Health Administration, Business Administration or a related field
    • Three years of program integrity, auditing, quality improvement or compliance-related experience in the healthcare industry (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

 

 OUR BENEFITS

  • Medical, Dental and Vision Plans
  • Ample Paid Time Off
  • 11 Paid Holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust Health and Wellness Program
  • EV Charging Stations
  • And many more

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve over 330,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here or check out this video


At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for sponsorship.

 

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