COMPLIANCE AUDITOR III (LEAD AUDITOR)
Company: Academy of Managed Care Pharmacy
Location: Rancho Cucamonga
Posted on: October 19, 2024
Job Description:
Compliance Auditor III
Maximise your chances of a successful application to this job by
ensuring your CV and skills are a good match.
Rancho Cucamonga, CaliforniaWhat 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.Key
Responsibilities:
- Independently conducts complex audits and monitoring activities
of internal health plan departments and external Plan delegates to
ensure compliance with Medi-Cal and Medicare regulatory and
contractual requirements, and operational plan requirements.
- Leads and reviews audits of the Plan's delegates to ensure
compliance with regulatory, contractual requirements, and HIPAA
Privacy Standards.
- Contributes to the development, implementation, and maintenance
of the Compliance Audit Program to ensure key performance
indicators are met and compliance risks are proactively
identified.
- Contributes to and supports comprehensive risk assessments,
provides recommendations on how risks may be addressed, develops
IEHP's Compliance Risk Universe, Heat Map, and maintains the
Compliance Risk Register and Audit Plan.
- Serves as a subject matter expert in compliance auditing, risk
assessment, risk mitigation planning, and other compliance and
regulatory related matters.
- Works closely with Compliance and Regulatory Department staff
and IEHP Leadership on strategic projects, including providing
recommendations, while also managing routine activities.
- Conducts 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.
- Writes and reviews 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 modifies tools to perform compliance audits and
reporting templates for communicating compliance audit
results.
- Facilitates compliance related data aggregation and the
analysis of compliance related data, indicators, and initiatives to
ensure the effectiveness of IEHP's Compliance Program.
- Validates the effective implementation of corrective action
plans (CAPs) from internal departments & delegates to ensure
appropriate completion and make necessary recommendations as needed
for compliance.
- Guides the work performed by Compliance Auditor I and II
positions.
- Conducts Entrance and Exit conferences.Commitment to Quality:
The IEHP Team is committed to incorporate IEHP's Quality Program
goals including, but not limited to, HEDIS, CAHPS, and NCQA
Accreditation.PerksIEHP 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.
- 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 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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Keywords: Academy of Managed Care Pharmacy, Oceanside , COMPLIANCE AUDITOR III (LEAD AUDITOR), Accounting, Auditing , Rancho Cucamonga, California
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