Hill Physicians Medical Group · 15 hours ago
Compliance Delegation Specialist II - 25-227
San Ramon, CA
Full-time
Onsite
Senior Level
$75K/yr - $82K/yr
5+ years expHill Physicians Medical Group is shaping the healthcare of the future through actively managed care. The Compliance Delegation Specialist II will assist in coordinating and implementing compliance delegation program responsibilities, ensuring adherence to healthcare regulations, and maintaining collaborative relationships with health plan representatives.
Health CareMedicalProfessional Services
Hiring Manager
Rohini Dinesh
Responsibilities
Proficient in Microsoft products (Outlook, Word, Excel, and PowerPoint) and Adobe
Utilizes and Maintains SAI360 Audit Management – External Audit Module and make recommendations to Compliance Delegation Manager and Compliance Officer as needed
Conduct and quality check monthly delegation reports timely and accurately
Ensure that Compliance Teams, Supervisors, and the Manager of Compliance Delegation are consistently kept informed and updated timely
Availability before and after business hours to support compliance department functions, and business needs
Attend calls, meetings, and other education sessions, as well as research and keep up to date on Health Plan requirements as they relate to PriMed/Hill Physicians
Receive, track, coordinate and monitor health plan and third-party emails for delegation audit process, requests for information, and correspondence between Health Plans, third parties, and PriMed
Assist with other functions as needed
Conduct research for assigned tasks and inquiries for delegation audits related to utilization management, claims, credentials, and other audit areas as assigned to support business needs
Prepare delegation audit tasks, including assessing that the request meets the delegation audit scope and delegation/contractual agreements. Tasks include but limited to documentation gathering, file pulls, policy and procedures pulls and reviews, and preparing documents for the delegation audits, reviewing that all responses are fact-based, appropriate, and addressing the request
Prepare for and assist Manager with the response for health plan delegation audits, meeting or speaking with delegation auditors, facilitating the delegation audit process, and participating in exit interviews and follow-up
Ensure that all your deliverables are submitted in a timely manner; tracked and documents are appropriate. Ensure remediation response of any non-compliant findings address the findings. Supporting evidence is appropriate and delivered to the requester timely
Critical thinking for all communications are clear, concise and timely
Deliver supporting evidence demonstrating implementation to health plan partners or third parties when requested
Analyze and interpret health plan audits results and distribute them to operational departments
Track and trend all health plan audit findings, collaborate with operational departments to implement strategies for future risk mitigation and improvement as it relates to those findings. (i.e. in the following areas: claims, pre-delegation audits, credentialing, provider access and availability survey results, and utilization management.) Collaboratively work with any impacted departments
Work with relevant operational departments to develop and implement health plan audit readiness strategies
Present delegation or agency audit results (findings/corrective action plans (CAPs) to operational departments
Publish delegation audit results internally as a resource for interdepartmental process improvement and/or best practice examples
Review of new regulations, guidelines, and delegation agreements and updates to determine coordination with the impacted operational departments
Provide an overview and ensure operations teams are familiar with the regulation and understand their respective obligations by required deadlines
Ensure policies and procedures, or other supporting documents are created for the implementation of the new regulation
Assists in the template/letter production process, including finalization of letters
Assists in the maintenance of letter templates by the Health Plan in the systems including initiation request for update, tracking, testing and finalization into production
Qualification
Required
Bachelor's Degree or equivalent experience required
5 Plus years of experience with managed healthcare and/or health plan audit and compliance
Knowledge of NCQA, CMS, DMHC, DHCS, California Health and Safety Codes
Knowledge of and direct experience with federal and state fraud, waste and abuse (FWA) laws
Communication and ability to explain complex topics (verbal and written)
Courteous and professional communication, collaboration, and ability to work with all levels of the organization and Health Plans
Excellent analytical, time management, leadership, and interpersonal skills
Focus on service with excellent time management, organizational, analytical, and interpersonal skills
Advanced with Adobe and Microsoft Applications. (Outlook, Word, Excel, PowerPoint, Project, SharePoint, etc.)
Analytical thinking to draw conclusions and critical thinking using logical reasoning to find solutions
Knowledge in Technology, system utilization, automation, privacy, and security
Proficient Project Management skills with attention to details
Outstanding communication skills and ability to work with all levels of the organization
Sound decision-making ability
Preferred
Familiar with Medicare and Medicaid/Medi-Cal programs preferred
Company
Hill Physicians Medical Group
Hill Physicians Medical Group is an independent physician association that focuses on providing innovative and quality healthcare.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
David Joyner
Chief Executive Officer
Recent News
2025-11-05
2025-09-12
Seattle TechFlash
2025-04-17
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