What are the responsibilities and job description for the Delegation Oversight Auditor position at Health Alliance Plan?
GENERAL SUMMARY:
This role is passionate about supporting the Vendor Management Office (VMO) as part of an effective Compliance program. The Compliance Program provides a framework to continually evaluate, monitor, and report performance and risk associated with subcontractors through a coordinated and consistent approach. This position is tasked with maintaining key vendor management data and documenting compliance review activities and findings. This role will be the key driver in maintaining internal regulatory governance and metrics around evaluation for subcontractors and other risk-identified vendors and ensuring annual audits and monitoring exercises are completed accurately, timely and reported per the compliance audit plan. Serve as corporate compliance representative to the subcontractors. Develops and implements audit procedures, manages audit data, outcomes, and follow-up activities, and performs documentation and operational risk assessments to identify areas for process improvement. Drives implementation of the improvements to achieve efficiencies and eliminate redundancy. Responsible for development of reports, work instructions and work programs related to compliant audit processes. Identify risk areas or trends to be reviewed for audit plan and as needed, based on external focus areas, including identification of root causes. Works closely with leadership to promote and administer subcontractor audit activities.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Identify regulatory risks, develop risk mitigation strategies, and document findings remediation through closure.
- Based on reviews and audits, works collaboratively with the subcontractor to support the design and implementation of corrective action plans, education, standard operating procedures, and system improvements.
- Help establish a consistent and repeatable process of subcontractor assessments and risk oversight.
- Educate and consult business stakeholders in developing and continuously improving the understanding of subcontractor risk and strategies to mitigate it.
- Execute locally, the global corporate standards to satisfy regulatory requirements around data privacy and sharing.
- Interact directly with subcontractors, as needed, to ensure the appropriate information is gathered and assessed prior to onboarding approval.
- Develop communications, as appropriate, to ensure processes and subcontracting regulatory policies are understood by internal and external stakeholder base.
- Provide strategic level thinking, subcontractor management leading practices, and continuous improvement ideas to ensure best in class processes.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's degree preferred. In lieu of a degree, six (6) years of Health Plan operational experience may be considered.
- Minimum of three (3) years of experience working in a Managed healthcare organization or health system’s Risk function or 3rd Party Oversight.
- Strong communication, problem solving, decision making and organizational skills necessary.
- Strong relationship building and conflict management skills are required.
- Must be results focused with the ability to work in an autonomous environment.
- Experience working with Federal and State Health programs.
- Experience working with commercial insurance programs.
