Manager, Compliance Monitoring & Auditing

Were looking for a Manager of Compliance Monitoring & Auditing someone whos ready to grow with our this position you will Manage oversee monitor and conduct internal and external auditing and real-time monitoring activities related to the Health Plans regulatory and contractual requirements in accordance with the Compliance Program as well as associated compliance oversight and reporting to align with regulatory and contractual requirements in accordance with the Compliance
Program and with HHSC TDI NCQA and Health Plan Senior Management.

Think youve got what it takes

Job Duties & Responsibilities
Ensure ongoing compliance with federal and state regulations and provide guidance and tools to assist the Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third parties (i.e. subcontractors) against Health Plan metrics policies regulations and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from Senior Management must be reviewed and/or revised at least once annually.
See to the Compliance Departments accurate and complete auditing documentation monitoring initiatives compliance-based education and correction of action plans. Analyze audit results and summarize areas of improvement needed. Review and update targeted training and educational materials that address deficiencies indicated by the auditing and monitoring program. Assist the Compliance Department with the issuance and management of corrective action plans related to auditing and monitoring indicators. Track and trend audit and monitor results. Maintain all auditing and monitoring records in accordance with record retention policy.
Manage and develop the monitoring and auditing team within the Compliance Department.
Monitor compliance activities using appropriate monitoring tools and techniques (Hotline department interviews committees direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues as appropriate. Report monitoring activities to senior leadership and governance committees as appropriate.
Maintain ongoing monitoring activities using appropriate monitoring tools and techniques (Hotline department interviews committees direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues as appropriate. Include monitoring activities in the quarterly audit report.
Develop and maintain an effective awareness and education program to ensure workforce knowledge of corporate compliance (including billing compliance CMS regulations HIPAA and HITECH regulations Texas Medicaid rules) by preparing and administering articles course content for required education initiatives and providing guidance to workforce. Assist with the development implementation and training of policies and procedures for billing compliance programs (HIPAA HITECH CMS The Joint Commission acceptance of gifts conflicts of interest billing and documentation).

Skills & Requirements
Bachelors degree required
5 years progressive compliance auditing healthcare and/or legal experience required

Highly Desired Licenses & Certifications:

• CIA-Certified Internal Auditor The Institute of Internal Auditors
• CPMA-Certified Professional Medical Auditor American Academy of Professional Coders
• CHCRA-Certified Healthcare Risk Auditor Association of Health Care Auditors and Educators
• CHA-Auditing for Compliance American Institute of Healthcare Compliance