Lead Compliance Auditor

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!

The Lead Compliance Auditor leads comprehensive audits and conducts key activities of the IEHP Compliance Audit Program. Develops audit programs and conducts audits of assigned areas and Plan delegates. Identifies risks in meeting or sustaining compliance with Federal, State, and contractual regulatory requirements. Prepares audit reports, detailing findings, and recommendations. Provides independent evaluations of operations, policies, and processes to validate compliance, evaluate effectiveness, and identify issues. Issues corrective action plans and leads the reviews for acceptance to ensures that all compliance issues are appropriately addressed. Leads and performs validation audits to determine if actions have been taken to mitigate identified risks. Participates in special reviews and assessments as necessary. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.

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.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Contribute to the development, implementation, and maintenance of the Compliance Audit Program to ensure key performance indicators are met and compliance risks are proactively identified.
2. Develop audit programs and testing procedures relevant to risk and test objectives.
3. Conduct audits of assigned areas and Plan delegates, including performing various audit procedures and documenting findings in audit work papers. Obtain and assess evidence ensuring audit conclusions are well-documented.
4. Ensure audit conclusions are based on a complete understanding of the process, circumstances, and risk.
5. Lead and perform validation audits to determine if actions have been taken to mitigate risks identified.
6. Consult across business operations, providing mentorship, and contributing specialized knowledge.
7. Identify and communicate issues raised, offering recommended solutions relevant to business and risk.
8. Apply subject expertise in evaluating business operations and processes, risk mitigation planning, and other compliance and regulatory related matters.
9. Provide independent evaluations of operations, policies, and procedures to validate compliance, evaluate effectiveness, and identify issues.
10. Maintain risks for assigned areas in the Compliance Risk Universe to ensure risk mitigation plans are developed and risks are assessed and refreshed as needed.
11. Lead the development of risk assessments to identify compliance risks posed to the Plan.
12. Lead the development and validation of corrective action plans (CAPs) from internal departments and delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
13. Provide training, recommend process improvements, and mentors junior level staff.
14. Lead Compliance assessments, as needed.
15. Create reports of audit and monitor outcomes for reporting to the Executive Compliance Committee and the IEHP Governing Board.
16. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• Minimum of seven (7) years in managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals
• Demonstrated experience, at a professional level, in an audit role and in supporting compliance audit program initiatives
• Experience conducting compliance audits of internal health plan operations and delegated entities
• Three (3) years of experience leading audits required
• Bachelor’s degree in a related field from an accredited institution required
  • Master’s degree in a related field from an accredited institution preferred
• Certified Internal Auditor (CIA), Certified Health Care Compliance (CHC), Certified Healthcare Auditor (CHA), CHIAP (Certified Healthcare Internal Audit Professional) required
  • Must become certified within twelve (12) months of initial date of hire if not certified upon hire

Key Qualifications

• Must have a valid California Driver's License
• Demonstrated understanding of audit standards and requirements, statistical data interpretation and applicability, risk assessment and control environments, audit theory and processes, and of the professional practice standards of internal auditing
• Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic health care environment
• Expert knowledge of compliance program principles and requirements
• Advanced knowledge of CMS Program Audit Protocols, DHCS Technical Assistance Guides, and DMHC Technical Assistance Guides
• Advanced knowledge of regulatory research and regulations that apply to Medi-Cal and Medicare Managed Care Health Plans
• 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
• Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail. Strong presentation and communication skills
• Expertise in utilizing systems and other compliance tools to streamline processes and reporting
• Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook, etc.)
• Advanced skills in MS Excel preferred
• Effective in a consulting role with the ability to become a trusted advisor
• Ability to maintain excellent interpersonal relationships within the department and at all levels of the organization
• Ability to organize and present data and results in well-organized communications and reports

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

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)