Job Details
Supervisor of Program Integrity
2025-08-05 Partnership HealthPlan of California Fairfield,CA
Description:
Education and Experience
Bachelor's Degree in Liberal Arts, Business Administration, Health
Care Administration, Political Science, or related field with two - three
(2-3) years' experience in the health care compliance field, with
knowledge of the Knox-Keene and Medi-Cal regulations; or an
equivalent combination of education and experience (4-5 years
minimum health care experience).
Special Skills, Licenses and Certifications
Certification in Healthcare Compliance (CHC) preferred or obtained
within 12 months of hire. Highly proficient in applicable business
software applications including PC usage, Microsoft Word, PowerPoint
and Excel. Knowledge of Policy development. State and federal
legislative processes. Medi-Cal programs. Research and program
planning methodology. Project Management. Valid California driver's
license and proof of current automobile insurance compliant with PHC
policy are required to operate a vehicle and travel for company
business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent
organizational skills with ability to prioritize assignments. Perform
policy development and implementation in the areas of Medi-Cal, other
insurance programs, long-term care, mental health, and other healthrelated programs. Demonstrated analytical skills. Ability to
communicate effectively, both verbally and in writing. Perform Project
Management activities.
Work Environment And Physical Demands
Ability to use computer keyboard and other business machines. More
than 50% of work time is spent at a computer monitor. When required,
ability to move, carry, or lift objects of varying sizes, weighing up to 35
pounds.
All HealthPlan employees are expected to:
HIRING RANGE:
$103,059.95 - $133,977.94
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
Overview
Oversees the day-to-day operations of Partnership HealthPlan of California's (PHC) Program Integrity Unit. Responsible for ensuring the timeliness of investigations related to potential or actual HIPAA and fraud, waste, and abuse. Supports training, provides direction to the Regulatory Affairs and Compliance (RAC) staff, and serves as an effective liaison for the organization and its internal and external community.
Responsibilities
- With RAC leadership, supports the management and goal setting for program integrity
operations - Supervises Regulatory Affairs Specialists and ensures staff follow procedures, policies
and protocols. Defines scope of work, deliverables and timeframes directly with senior
staff - Researches complex HIPAA and/or fraud cases to ensure accurate and timely response
utilizing all applicable State and Federal regulations, available data and documentation,
and facts of the case. Facilities case conferences with RAC leadership as needed - Supports PHC's multi-faceted approach to detect and protect against fraud activity
- Responsible for the completeness and accuracy of the tracking systems and records of all
reports and investigations related to potential or actual HIPAA and/or fraud - Participates and represents PHC in meetings and calls with regulators and associations
and summarizes key points and impact to PHC programs - Provides HIPAA/FWA training and education to PHC operational departments to promote
awareness of and adherence with program integrity requirements - Maintains work plans, dashboards, and other tools intended to provide transparency and
accurate reporting of program integrity activities and trends - Responsible for monitoring industry trends and making recommendations for PHC's
program to proactively mitigate HIPAA and/or fraud risks and develops and supports
implementation of interventions
- Participates in special projects and assignments, as needed.
Education and Experience
Bachelor's Degree in Liberal Arts, Business Administration, Health
Care Administration, Political Science, or related field with two - three
(2-3) years' experience in the health care compliance field, with
knowledge of the Knox-Keene and Medi-Cal regulations; or an
equivalent combination of education and experience (4-5 years
minimum health care experience).
Special Skills, Licenses and Certifications
Certification in Healthcare Compliance (CHC) preferred or obtained
within 12 months of hire. Highly proficient in applicable business
software applications including PC usage, Microsoft Word, PowerPoint
and Excel. Knowledge of Policy development. State and federal
legislative processes. Medi-Cal programs. Research and program
planning methodology. Project Management. Valid California driver's
license and proof of current automobile insurance compliant with PHC
policy are required to operate a vehicle and travel for company
business.
Performance Based Competencies
Excellent oral and written communication skills. Excellent
organizational skills with ability to prioritize assignments. Perform
policy development and implementation in the areas of Medi-Cal, other
insurance programs, long-term care, mental health, and other healthrelated programs. Demonstrated analytical skills. Ability to
communicate effectively, both verbally and in writing. Perform Project
Management activities.
Work Environment And Physical Demands
Ability to use computer keyboard and other business machines. More
than 50% of work time is spent at a computer monitor. When required,
ability to move, carry, or lift objects of varying sizes, weighing up to 35
pounds.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan's policies and procedures as they may from time to time be updated.
HIRING RANGE:
$103,059.95 - $133,977.94
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.