Compliance Auditor III

3 days ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time
Compliance Auditor III Job Description

At Inland Empire Health Plan, we are committed to delivering high-quality healthcare services to our members. We are seeking a highly skilled Compliance Auditor III to join our team.

Key Responsibilities:
  • Conduct complex audits and monitoring activities to ensure compliance with Federal and State regulatory and contractual requirements.
  • Lead and review audits of delegated entities to ensure compliance with regulatory, contractual requirements, and HIPAA Privacy Standards.
  • 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.
  • Serve as a subject matter expert in compliance auditing, risk assessment, risk mitigation planning, and other compliance and regulatory related matters.
  • Work closely with Compliance and Regulatory Department staff and IEHP Leadership on strategic projects, including providing recommendations, while also managing routine activities.
  • Conduct complex compliance audits, including development, scoping, implementation, monitoring, and evaluation of operational business units within the health plan, and ensures appropriate communication of outcomes and findings.
  • Write and review Audit Programs, audit workpapers, and audit reports of other Auditors based on audit results and ensures accurate and quality of audit reporting.
  • Develop and/or modify tools to perform compliance audits and reporting templates for communicating compliance audit results.
  • Facilitate compliance related data aggregation and the analysis of compliance related data, indicators, and initiatives to ensure the effectiveness of IEHP's Compliance Program.
  • Validate the effective implementation of corrective action plans (CAPs) from internal departments & delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
  • Guide the work performed by Compliance Auditor I and II positions.
  • Conduct Entrance and Exit conferences.
Commitment to Quality:

The IEHP Team is committed to incorporating IEHP's Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation.

We offer a 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.

We are an equal opportunity employer and welcome applicants from diverse backgrounds. If you are passionate about delivering high-quality healthcare services and committed to excellence, we encourage you to apply for this exciting opportunity.

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