Compliance Auditor III

3 weeks ago

Rancho Cucamonga, United States IEHP Full time

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 Compliance Auditor III is responsible to lead and conduct key activities of the IEHP Compliance Audit Program. The Compliance Audit III will oversee compliance auditing and monitoring initiatives to assess and identify compliance risks with Federal and State regulatory and contractual requirements. The Compliance Auditor III is responsible for conducting compliance audits, reporting results, identifying risks, establishing compliance monitoring processes, and assessing regulatory compliance of Health Plan operations.

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

Education & Experience

* Bachelor's degree in a related field from an accredited institution required.
* Master's degree in a related field from an accredited institution preferred.
* Minimum of six (6) years in a 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. 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. Demonstrates ability to think and work effectively under pressure and accurately prioritize and complete multiple assignments within established timeframes.
* Three (3) years of experience in leading audits.

Key Qualifications

* 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.

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

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