Compliance Auditor

Description

Salary Range:  $92,025 - $133,437

Job Summary

Under the direction and supervision of the Audits, Monitoring, and Oversight (AMO) Manager, and through collaboration with Directors and Management level staff, this position directs and conducts audit activities of varying complexity and supports initiatives of moderate to complex difficulty related to CenCal Health’s AMO program. This includes the performance of routine and complex AMO activities of internal departments and external partners to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements, as well as drafting, reviewing, and coordinating corrective action plans.

Duties & Responsibilities

• Directs and conducts routine and complex compliance audit activities of internal departments and/or external partners, documenting results in audit work papers, developing detailed document request lists, conducting audit conferences and walk-throughs, and proposing recommendations for improvement.
• Reviews documented processes against contractual, Federal, State, CMS, and NCQA standards.
• Directs and conducts regulatory research to identify gaps and provides an interpretation of regulations to ensure appropriate application.
• Develops audit scope and audit tools based on regulatory compliance with DHCS, DMHC, NCQA and CMS requirements.
• Writes clear and concise audit reports based on audit results, ensuring accuracy and quality of audit reporting and utilizing knowledge to determine findings.
• Develops and implements quality improvement and corrective action plans (CAPs) based on risk analysis, audit findings, or delegate performance, to ensure evidence of corrective actions are in place.
• Maintains of CenCal Health’s risk logs and audit tools.
• Directs and conducts routine monitoring activities to ensure compliance with regulatory and contractual requirements.
• Creates reports and analyzes data for reporting to management, the Delegation Oversight Committee, Compliance Committee, and Board of Directors.
• Responsible for audit announcement memos.
• Directs and conducts audits of assigned areas, including performing various audit procedures and documenting audit findings.
• Performs follow-up audits to determine if management has taken action to mitigate the risks identified.
• Provides independent evaluations and maintains operational controls, tools, policies, and procedures.
• Develops audit materials for entrance and exit conferences.
• Trains internal audit participants/ business owners on audit process and/or tools.
• Complies with HIPAA, Privacy, and Confidentiality laws and regulations.
• Other duties as assigned.

Qualifications

Knowledge/Skills/Abilities

Required:

• Extensive audit experience with DHCS, CMS, DMHC, and/or NCQA and understanding of audit standards and requirements;
• Excellent written and verbal communication skills with strong business writing aptitude;
• Experience researching, compiling, and organizing information from various sources;
• Strong organizational skills and attention to detail;
• Strong skills in problem identification, analysis, resolution, organization, and prioritization;
• Demonstrate ability to accurately apply and interpret clinical guidelines;
• Ability to work productively with all Plan staff;
• Ability to coordinate work between departments;
• Ability to work with minimal supervision, both independently and in teams;
• Ability to reprioritize workload as needed; and
• Attention to detail and accuracy.

Desired:

• Internal healthcare auditor certification (or ability to achieve certification within 1 year);
• Certified Health Care Compliance (CHC) certification (or ability to achieve certification within 1 year); and
• Experience in managed health care and health care compliance.

Education & Experience

• Advanced degree – Bachelor’s (preferred) or Associate’s Degree; and
• 2 years of compliance or auditing experience in a healthcare environment.

Salary : $92,025 - $133,437