Customer Solution Center Audit Readiness Specialist II Overseeing Compliance

THIS IS A HYBRID ROLE YOU MUST BE IN OFFICE DURING AUDITS

This role ensures the Customer Solution Center (CSC) is prepared for regulatory audits. Youll develop audit strategies conduct reviews and identify areas for improvement.

Responsibilities:

• Conduct audits across various CSC processes (enrollment calls authorizations etc.)
• Analyze findings and recommend corrective actions
• Stay updated on regulations from multiple governing bodies (DHCS CMS NCQA)
• Lead the audit process presenting findings and ensuring action plans are implemented
• Collaborate with CSC departments to improve processes and maintain compliance

Qualifications:

• Bachelors degree (or equivalent experience)
• Minimum 5 years experience in healthcare regulatory auditing (Appeals Call Centers Enrollment)
• Strong analytical interpersonal and organizational skills
• Proficiency in MS Office and familiarity with healthcare regulations (MediCal Medicare)

Remote Work :

No