Compliance Auditor I

Location US-CA-Rancho Cucamonga
ID 2024-3924
Category
operations
Position Type
Regular Full-Time
Work Model
Hybrid

Overview

What you can expect! 

 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

 

Under the general supervision of the Compliance Audit & Oversight Manager, the Compliance Auditor I conducts and assists with compliance audits and supports initiatives related to the Compliance Audit Program. The Compliance Auditor I is responsible to perform routine audit and monitoring activities of internal health plan departments and external Plan delegates to ensure compliance with Medi-Cal and Medicare regulatory and contractual requirements, and operational plan requirements.

 

Key Responsibilities

 

1. Conducts routine compliance audit activities, including detailed testing activities, documenting results in audit work papers and proposing recommendations for improvement. 
2. Conducts audits of the Plan’s delegates to ensure compliance regulatory, contractual requirements, and HIPAA Privacy Standards.
3. Supports the development of risk assessments to identify compliance risks posed to the Plan. 
4. Supports the maintenance of IEHP’s Compliance Risk Universe, Compliance Risk Register, and Audit Plan.
5. Assists and supports the development, implementation, and maintenance of the Compliance Audit Program to ensure key performance indicators are met and compliance risks are proactively identified. 
6. Conducts routine monitoring activities to ensure compliance with regulatory and contractual requirements. 
7. Assists with developing and maintaining audit tools based on regulatory compliance with DHCS, DMHC, and CMS requirements.
8. Assists in writing audit reports based on audit results and ensures accurate and quality of audit reporting.
9. Validation of effective implementation of corrective action plans (CAPs) from internal departments & delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
10. Creates reports and analyzes data for reporting to management, the Compliance Committee, Auditing & Monitoring Committee, and Governing Board.
11. Conducts regulatory research and provides interpretation of regulations to ensure appropriate application. 
12. Prepare audit programs and conduct audits of assigned areas, including performing various audit procedures and documenting audit findings in the work papers.
13. Perform and coordination follow-up audits to determine if management has taken action to mitigate risks identified.
14. Provide independent evaluations of operational controls, policies, and procedures.
15. Assists and supports the development of materials for audit Entrance and Exist conferences.

 

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits

Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more!

  • CalPERS retirement
  • 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account – Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities

Qualifications

Education & Experience

  • Minimum of three (3) or more years in managed care operations, working with one or more of the following areas
  • Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals
  • Demonstrates ability to think and work effectively under pressure and accurately prioritize and complete multiple assignments within established timeframes
  • One (1) year of public or private industry audit, quality assurance/quality improvement experience, preferably in health care or other highly regulated industry
  • Bachelor’s degree from an accredited institution required

 

 

 

 

Key Qualifications

  • Possess strong written and verbal communication skills, including a strong business writing aptitude
  • Possess strong problem solving and creative thinking skills and the ability to reprioritize workload as needed
  • Must be detail oriented, self-directed, and work with minimal supervision, both independently and in teams 

 

 

 

 

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

Hybrid

Pay Range

USD $30.72 - USD $35.33 /Hr.

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