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Compliance Auditor ** 
(Job)

resume-library  |  United States  |  

Ref:
PARTNER-3XQFZ9
Direct:
Employer:
Location:
United StatesUnited States (US)
Category:
Accounting/Accounting
Work Type:
Permanent
Work Time:
Full Time
Tags:
job,united-states,resume-library

Description 

Compliance Auditor **

Overview:

Under supervision and direction of the Regulatory Affairs and Compliance (RAC) leadership, this position provides support for and helps to oversee plan-wide auditing and monitoring activities through all stages from planning to satisfactory completion. Helps to maintain the compliance audit program including processes, procedures, instructional materials, and record keeping systems.



Responsibilities:

Maintains working knowledge of health plans governing regulatory, statutory, and accreditation requirements



Periodically synthesize written regulatory and accreditation guidance to inform the auditing program/process



Maintains and demonstrates working knowledge of audit principles and methodology



Supports auditing and monitoring activities to ensure compliance and serves as a resource for internal stakeholders



Participates in the planning and scheduling of plan-wide auditing and monitoring activities



Develops and maintains productive working relationships with audit stakeholders through individual contact and/or group meetings



Develops and maintains audit materials including, but not limited to, policies, communications, work plans, audit tools, tracking tools, and audit reports



Primary person responsible for tracking audits through completion and maintaining systems to record and report on audit progress



Provides technical and administrative support for stakeholders through all audit phases



Responsible for communicating auditing and monitoring milestones, deliverables and outcomes with internal stakeholders



Recommends corrective action for detected deficiencies as a result of auditing and monitoring and as necessary, conducts reassessments of performance once corrective actions have been implemented



Drafts requests for information and communications to audit stakeholders in order to clearly convey audit requirements, results and corrective actions needed to obtain compliance



Proven auditing expertise with the ability to educate others on the complexities of the auditing process and methodology



Works to influence stakeholders regarding oversight obligations, best practices, and opportunities for improvement



Demonstrated ability to effectively gather, organize, and analyze information and write reports and organize work efficiently



Annually reviews audit processes to assess effectiveness of current methodologies and as appropriate, makes recommendations for improvement



Assists with qualitative risk analysis and remediation efforts



Coordinates onsite regulatory audits.



Qualifications:

Education and Experience



Bachelor’s Degree in Liberal Arts, Communications, Business Administration, Health Care Administration, Political Science, or related field; minimum two years auditing experience, preferably in a managed care or health care environment; two – three (2-3) years of experience in the health care field, managed care experience preferred, with knowledge of Medi-Cal requirements and preferably, Knox- Keene and/or Medicare regulations; or an equivalent combination of education and experience.



 



Special Skills, Licenses and Certifications



Project management skills preferred. Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Project, typing speed of 30 wpm. 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 work effectively under pressure and accurately prioritize assignments, maintain effective filing systems, and meet deadlines. Ability to work under minimal supervision and exercise independent judgment. Diplomacy and tact in handling sensitive information. Ability to interact with internal and external stakeholders effectively, handling all assignments with efficiency. Must be able to handle multiple tasks and meet deadlines. Excellent judgment.



 



Work Environment And Physical Demands



Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of 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.



 



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.



 



2022-2154