The position will conduct routine oversight, monitoring and auditing of internal business functions. The Auditor will ensure compliance with state, federal, and accreditation standards.
POSITION RESPONSIBILITIES:
- Informs various departments of changes to regulatory requirements.
- Assists in the development of audit tools; issues corrective action plans to address identified issues.
- Completes validation audit for applicable areas of identified deficiencies to ensure remediation efforts are effective and sustained.
- Conducts annual audits for applicable areas; ensures vendors remain in accordance with the regulatory requirements or contractual obligations.
- Participate in workgroups that address internal activities that need improvement and meet contractual requirements with the Center for Medicare and Medicaid (CMS), California Department of Health Services (DHS), California Managed Risk Medical Insurance Board (MRMIB), Department of Managed Health Care (DMHC), and other applicable entity.
- Participates in the Audit and Oversight Committee (AOC) meetings.
- Serves as knowledge expert for assigned functional areas; may act as a liaison with other areas and business units.
- Other projects and duties as assigned.
Required Skills
- Demonstrate and motivate others in effective team coordination and cooperation.
- Establish and maintain effective working relationships with all levels of staff, other programs, agencies and the public.
- Effectively utilize computer and appropriate software (Microsoft Office Suite) to produce documents, charts, spreadsheets, and or other information applicable to position or assignment.
Required Experience
EXPERIENCE & EDUCATION:
- Bachelor’s degree in a health care field or an equivalent combination of education and experience.
- 2+ years experience within a managed care plan and quality management required.
- 2+ years audit experience in the healthcare field required.
KNOWLEDGE OF:
- Managed care compliance for Medi-Cal, D-SNP and MMP plans.
Grade: K
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