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External Audit Coordinator

2 months ago

Alameda, California, United States Alamedaalliance Full time
Position Overview

Under the guidance of the Supervisor of Health Plan Audits, this role is integral to the Compliance Program at Alameda Alliance for Health (AAH), focusing on external and delegated auditing functions.

Key Responsibilities
  • Lead and coordinate external audits of AAH's delegated entities to ensure adherence to regulatory and contractual obligations.
  • Identify and recommend enhancements to the external audit control framework.
  • Manage the scheduling of delegated audits efficiently.
  • Conduct routine and ad-hoc audits of delegated entities, assessing compliance with regulations and operational controls through detailed examination of records and documentation.
  • Develop and refine audit tools to reflect current regulatory standards.
  • Design and implement corrective action plans based on audit findings to mitigate identified risks.
  • Facilitate preparatory 'mock' audits, including policy reviews and technical assistance sessions.
  • Assist in maintaining the AAH audit calendar.
  • Present audit outcomes to the Alliance Compliance Committee for evaluation and approval on a quarterly basis.
  • Collaborate with external regulatory bodies and internal departments on documentation requests and audit preparations.
  • Contribute to the development and review of Alliance policies and procedures.
  • Provide training and support to delegated entities in adopting best practices in compliance with established policies.
  • Stay informed on state and federal legislation affecting publicly-funded managed care organizations.
  • Conduct research and analysis of relevant regulations, including the Knox-Keene Act and Title 22.
  • Monitor the regulatory landscape and escalate compliance issues as necessary.
  • Complete additional projects and responsibilities as assigned.
Essential Functions
  • Audit both delegated entities and internal processes as required.
  • Update audit tools and criteria metrics as necessary.
  • Analyze and interpret legislative and regulatory changes impacting company policies.
  • Ensure effective communication with internal and external stakeholders.
  • Support the organization’s adherence to its Code of Conduct and all regulatory requirements.
Physical Requirements
  • Prolonged periods of visual work at a desk or computer.
  • Frequent sitting and data entry tasks.
  • Regular communication with staff and business associates.
  • Occasional lifting of items weighing up to 30 lbs.
  • Regular walking and standing activities.
Qualifications

Education: Bachelor’s degree in a relevant field is required.

Experience: A minimum of two years in healthcare, auditing, compliance, or related fields is essential.

Skills: Strong interpersonal skills, analytical abilities, and proficiency in Microsoft Office Suite are necessary. The ability to work independently and manage projects effectively is critical.

The Alliance is committed to equal opportunity employment and values diversity in its workforce.