Brief job information:
Under the supervision of the Chief Compliance Officer, the Auditor is responsible for performing both planned and ad hoc internal department and delegated functions’ audits and conducts or assists in investigations of reported compliance issues. The Auditor supports the compliance program by developing audit and monitoring tools that are aligned with State and Federal regulatory standards.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Assists the Chief Compliance Officer (CCO) with the development and integration of the Compliance Program’s audit work plan and activities.
- Maintains the compliance audit program, including schedules, standards, processes, reports, and tools in close collaboration with the Compliance Officer.
- Conducts routine and ad hoc audits and reviews documents and records to assess whether operational areas meet state, federal, and contractual requirements. Manages each audit from start to completion including:
- Planning and verification of the audit sample universe.
- Conducting review of supporting documentation.
- Preparing aggregate summary reports.
- Completes audit documentation and reporting in a timely manner and in accordance with established Federal (CMS) and State (DMHC and DHCS) auditing methodologies and other auditing professional standards.
- Coordinates implementation of internal and external corrective action plans, monitoring progress and completion, coordinating interviews and document gathering; Conduct re-audits to verify corrective actions were fully implemented and effective.
- Tracks and trends compliance audit statistics.
- Maintains comprehensive audit and monitoring tools policies and procedures related to the compliance audit program, including schedules, standards, processes, reports, record keeping and audit tools.
- Develops and prepares reports on compliance audit program activities for submission to internal stakeholders as well as state and federal oversight agencies.
- Reads, understands, and maintains current knowledge of complex federal and state laws, regulations, rules, and bulletins applicable to the company’s corporate compliance program.
- Assists with special project preparation and follow-up, as needed, under the direction of the CCO
- At the direction of the CCO, attends and presents to various committees or meetings.
- Bachelor’s degree in business, health administration, public health, or a related field. Equivalent combination of experience and/or education may substitute with a preference for three to five years progressive relevant work experience.
- Three to five years’ experience in a compliance, or healthcare auditing role required. Managed care and/or Medicaid/Medicare experience desired.
- Must be detailed oriented with excellent problem-solving skills.
- Demonstrates support for the company’s mission, vision, and values.
- Position requires excellent written and verbal communication skills.
- Ability to assimilate and process complex verbal and written communications.
- Strong organizational and time management skills required to multitask effectively and adapt to changing priorities and responsibilities.
- Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, and Outlook) and computer database programs.
- Must be able to manage multiple priorities and projects with tight deadlines.
- Utilizes high degree of self-direction by analyzing an issue, developing a plan to resolve, and implementing the resolution.
- Strong knowledge of managed care health plan functions and interactions as they related to compliance.
- Basic knowledge of compliance systems, processes, and reporting.
In our efforts to control the spread of COVID-19 and its variants, CCHP requires that its employees be fully vaccinated as of their start date. If you require medical or religious accommodation we will engage in the interactive process with you. Proof of vaccination will be required prior to start. If we make you an offer and you are not yet vaccinated, we will accommodate a delay in the start date. CCHP may also mandate that its employees receive vaccine boosters, and all accommodation laws will be followed.