Compliance Auditor

4 weeks ago

Chula Vista, United States Community Health Group Full time

POSITION SUMMARY

The Compliance Auditor will support the director in compliance with audits of various functional areas including evaluation of effectiveness of risk management practices or internal controls. In addition, the auditor will analyze audit results, prepare presentations of findings, and develop recommendations meant to reduce risk and increase the protection of organizational assets. Coordinates with external auditors as needed.

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs, and services are accomplished in a timely and efficient manner by CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D and Special Needs Plan (SNP) and DHCS - Medical agency.

RESPONSIBILITIES

* Supports strategic initiatives with significant scope and impact, demonstrating sound decision-making, initiative, and intuitive thinking.


* Assists in the development and maintenance of audit systems to ensure compliance with regulatory, contractual, and internal policy requirements.


* Monitors and tests processes and control environments, reporting results and evaluating the organization's adherence to regulations.


* Contributes to comprehensive internal and external compliance audits throughout the organization.


* Participates in the creation of audit reports, tracks audit findings, and ensures follow-up on management actions.


* Assists in the development of the annual audit plan, demonstrating strong project management skills to meet deadlines.


* Maintains professionalism and confidentiality in sensitive situations.


* Cultivates positive working relationships with clients, vendors, and internal stakeholders.


* Collaborates in the creation, review, and update of compliance policies and procedures.


* Ensures alignment of all business operations and policies with regulatory obligations and federal, state, and local employment laws.


* Provide guidance and advice to senior management on compliance-related matters.


* Handles communication with internal and external stakeholders effectively.


* Monitors and reports on Key Risk Indicators (KRIs) and Key Performance Indicators (KPIs).


* Reviews legal agreements and investigates complaints thoroughly.


* Implements an efficient compliance plan by federal and state laws to mitigate fraud, waste, and abuse risks.


* Conducts detailed audits of business processes to identify and mitigate compliance risks.


* Informs staff and administrators about potential regulatory changes and recommends compliance strategies.


* Enforces compliance programs by promptly detecting misconduct and devising corrective plans.


* Gathers, analyzes and summarizes management information to compile relevant compliance reports.


* Documents audit tests and findings to complete audit-related documentation and memorandums.



Qualifications

Education:

* Bachelor's degree in information management, Finance, Business, or Healthcare Administration/HCCA certification preferred.



Experience/Skills:

* 5+ years of experience in Compliance or Auditing


* Familiarity with privacy-related regulations, such as HIPAA


* Proficiency in Microsoft Office; specifically, Word, Excel Outlook.


* Strong organizational skills and a discretionary approach when handling sensitive data.


* Prior experience developing and preparing reports of compliance program activities, including the collecting of data, and reporting findings.


* Self-motivated with a proven ability to work independently and continually calibrate priorities with minimal supervision.


* Strong interpersonal skills including written and verbal communication.


* Demonstrated ability to perform quality client service.


* Advan



Physical Requirements:

* Occasional travel within San Diego and outside San Diego County


* Prolonged periods of sitting


* May be required to work evenings and/or weekends.



The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Must have current authorization to work in the USA

Community Health Group is an equal-opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and training. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action.

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