Manager, Internal Audit - 25-89

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DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Under the direction of the Compliance Officer, the Manager of Internal Audit supports compliance across PriMed / Hill Physicians Medical Group (HPMG) / Hill Physicians Care Solutions (HPCS) by independently execute end-to-end internal audits, including performing effective risk assessments, planning, assessing the design of controls, testing the effectiveness of controls and reporting results to management. This includes but is not limited to conducting compliance, operational, financial and system auditing activities, analyzing findings, identifying areas of risk, and recommending interventions based on audit results as it relates to compliance with industry standards including but not limited to (e.g. NCQA), contracts, billing and coding requirements, policies and procedures, contracts, and state and federal regulatory requirements across all regions. The Manager of Internal Audit is solutions oriented, critical thinker and will collaborate across the organization to ensure alignment and efficiency in audit strategy.

The Manager of Internal Audit is responsible for reviewing and evaluating the compliance, privacy, and operational areas/business units with compliance with the regulatory and contractual requirements. The position contributes to overall operating efficiency by ensuring adherence to effective and efficient operating procedures and by evaluating systems of internal control throughout the system. The incumbent assists in assessing the risk of loss or impairment of system assets and recommends internal controls and procedures to the Compliance Officer.

The Manager of Internal Audit is responsible for designing and implementing audit programs and communicates audit findings and recommendations to the Compliance Officer. The position obtains statistics and the information necessary to maintain an audit risk assessment system for all auditable areas. This individual must conduct audit work in compliance with the standards for the professional practice of internal auditing as identified by the Association of Healthcare Internal Auditors and Institute of Internal Auditors. He/she performs the role by demonstrating technical ability and an understanding of job expectations while working in compliance with organizational policies and procedures.

ESSENTIAL RESPONSIBILITIES:

Review and Evaluate Operating Areas of PriMed and Related Enterprise Partners

• Perform all aspects of internal audits, including assessing compliance risk, developing audit work-plans in collaboration with other departments, performing all audit work steps, documenting and reporting findings and recommendations, and following up to confirm findings are appropriately remediated. Areas of audit include, but are not limited to, Compliance, Privacy, FWA, Claims, Clinical Documentation, Medical Records, Coding and Billing, Utilization Management, Qulaity, Care Management, Network Practices, Sub-delegation, Corporate Compliance as well as compliance with policies and procedures, program descriptions, operational processes, etc.
• Conduct interviews, review documents, develop and administer surveys, compose summary memos, and prepare working papers.
• Develop, plan, and coordinate preparatory “mock” audits, including reviews of policies & procedures, DMHC & DHCS technical assistance guides (TAGs), CMS audit tools to conduct question and answer sessions, and lead departments through audit preparatory measures as needed.
• Implement audit work steps by preparing audit tools for audit scope in alignment with regulatory and delegation requirements, sending audit communications, requesting and reviewing evidentiary documents, records and reports, conducting both remote and onsite auditing at provider office locations when necessary, accurately recording findings, and preparing summary reports and recommendations.
• Develop, implement and track improvement strategies and implement appropriate intervention in response to analytics, risk assessments, audit findings (both internal and external), and reported potential non-compliance, by developing meaningful improvement work plans executed within expected timeframes, to include administration, recommendation and/or coordination of auditing and monitoring, policy revision, training, and corrective action plans as appropriate.
• Provide immediate feedback to Compliance Officer, management and other stakeholders to discuss compliance audit plans and results; and make recommendations to resolve compliance audit findings requiring remediation.
• Apply a strong knowledge of audit fundamentals and requirements and demonstrate critical thinking to identifying risks.
• Understand and remain current with industry changes; integrate changes and new requirements into auditing practices as aligned with business objectives.
• Monitor and assess overall effectiveness of audit program, corrective action, and work plans.
• Develop policies, procedures, ops processes, and workflows around auditing and monitoring.
• Facilitate ongoing training and education based on audit findings.
• Perform operational and financial audit assignments and other audit services identified by the Compliance Officer.
• Identify areas/activities requiring audit review through observations made during audit assignments.
• Obtain an understanding of the systems of control for each auditable area by reviewing policies and procedures, communicating with staff, and observing processes.
• Design and perform audit programs that adequately test effectiveness of controls, compliance to established policies and procedures, and compliance to federal and state laws and regulations by using standard audit techniques.
• Prepare and maintain completed audit workpapers, documenting the basis for the recommendations made relative to the audit assignments.
• Perform reviews in a thorough manner to propose meaningful recommendations.
• Assist in the development of risk analyses and annual audit plans.
• Complete assignments in an efficient manner with minimal interference with operations.
  
  
  

Communicate Audit Findings and Recommendations

• Describe each system examined to adequately identify controls, using acceptable documentation methods.
• Report all significant findings to the Compliance Officer.
• Prepare written reports for each audit conducted.
• Make timely evaluations of current audit procedures and goals and propose changes in them as situations warrant.
  
  
  

Obtain Statistics and Information Necessary to Accurately Maintain an Audit Risk System

• Collect accurate and consistent information, needed to maintain a risk assessment system for all auditable areas, as established.
• Demonstrate knowledge of the risk assessment system by identifying valid information and significant changes.
• Collaborate with the Compliance Officer and the Enterprise Risk Management team to:
• Contribute to the development and maintenance of the organization's risk register.
• Assist in conducting enterprise-wide risk assessments.
• Support the integration of compliance and internal audit activities with broader ERM initiatives.
• Help identify emerging risks and trends that may impact organization.
• Assist in the design and implementation of the risk assessment program.
• Perform risk assessments,
• Analyze findings.
• Create customized, detailed reports for the Compliance Officer and Committees.
• Assist with Fraud, Waste and Abuse (FWA) and Discrimination cases if necessary
• Complete other special projects and duties assigned.
  
  
  

Maintain Knowledge of Professional Auditing Standards

• Maintain a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting publicly funded managed care organizations including Medicare advantage and Part D Programs, and their potential impact on the risk profile.
• Maintain awareness of changes in auditing principles and practices and related areas to maintain professional competence.
• Comply with the standards of professional practice and internal auditing as established by the Association of Healthcare Internal Auditors best practices and Institute of Internal Auditors.
  
  
  

Professional Development

• Complete a personal goal to enhance skills to meet departmental initiatives.
  
  
  

SKILLS AND EXPERIENCE REQUIRED:

• Effectively prioritize managing multiple projects at the same time, ensuring that high-quality deliverables are completed timely.
• Strong leadership, organizational, and communications skills.
• Ability to work effectively with a variety of customers including physicians, providers, managers, office staff, health plans, sub-delegates, and internal staff members.
• Critical thinking skills and analytical experience in risk assessment and mitigation, auditing, strategic planning, implementation and solving complex problems and issues.
• Comfortable navigating various system applications.
• Policy and procedure writing with emphasis on regulatory guidelines.
• Advanced proficiency in all Microsoft applications and computer programs including Epic, GRC, and database applications required.
• Knowledge of National Committee for Quality Assurance (NCQA), MCG, International Classification of Diseases (ICD-9/ ICD-10), Current Procedural Terminology (CPT), Health Care Common Procedure Coding System (HCPCS), Universal Billing (UB), Knox Keene, and other industry related state and federal statutory and regulatory requirements.
• Applying the principles and practices of internal auditing procedures.
• Working effectively independently, managing tasks in a fast-paced environment.
• Self-starter with ability to drive independent problem solving, comfortable with a constantly evolving environment.
• Engaging and persuasive communicator who is audience-aware and able to articulate ideas, thoughts, and questions clearly and appropriately.
• Effective verbal and written communication skills.
• Providing excellent customer service skills and the ability to work with a diverse group of people.
• Unquestioned ethics and integrity.
• Maintaining confidentiality of records and system.
  
  
  

Required Education

• Master’s Degree in HealthCare, Business Administration or related field.
• Certified Healthcare Internal Audit Profession (CHIAP), Certification as an Internal Auditor (CIA), or Internal System Auditor (CISA).
  
  
  

Required Experience

• Five (5) years’ hands on experience in audit and internal controls of a healthcare organization. (Health Plan Operations and Medicare Advantage Compliance Management)
• Knowledge of regulatory requirements (NCQA, DHCS, CMS, DMHC, etc.)
• Excel - VLOOKUPS, Pivot Tables. Power BI
  
  
  

Preferred Experience

• 5 years Health Plan Operations with Audit, Internal Controls, and Compliance hands on experience.
• Experience with Governance Risk Compliance (GRC) systems. Compliance/ SAI360
• Additional to Audit Certification - Certified in HealthCare Compliance (HCCA – CHC), Certified Professional Coder (CPC).
  
  
  

Additional Information:

Salary: $121,000 - $159,000 Annual

Hill Physicians is an Equal Opportunity Employer