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Job Requirements of Manager Compliance Monitoring & Auditing:
-
Employment Type:
Contractor
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Location:
Houston, TX (Onsite)
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Manager Compliance Monitoring & Auditing
Careers Integrated Resources Inc
Houston, TX (Onsite)
Contractor
Tittle: Manager Compliance Monitoring & Auditing
Location: Houston, TX - 77401 (Hybrid - 2 day s onsite in a week)
Duration: 3+ Months
Shift: General
Position Description:
Duties:
Skills:
Education:
Preferred:
Location: Houston, TX - 77401 (Hybrid - 2 day s onsite in a week)
Duration: 3+ Months
Shift: General
Position Description:
Duties:
- Manage, oversee, monitor, and conduct internal and external auditing and real-time monitoring activities related to the Health Plan's 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.
- 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) aProductst Health Plan metrics, policies, regulations, and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from Senior Management and must be reviewed and/or revised at least once annually.
Skills:
- Knowledge of general business systems and their related control structures, extensive knowledge healthcare regulatory environment, including CMS, HIPAA, and HITECH regulations.
- Must have technical knowledge related to personal computers and business information systems and related applications.
- Ability to analyze data and situations, determine errors and potential problems arising from the analyses, and formulate practical and workable solutions to the problems identified.
- Must be able to utilize computer word processing, spreadsheet and graphics software applications.
- Must be able to work effectively with all levels of management and be able to write clearly and effectively.
- Would prefer if they had Tapestry experience
- Mandatory provider contract, benefit, fee schedule configuration experience
Education:
- Required - Bachelor's Degree
- 5 years progressive compliance, auditing, healthcare, and/or legal experience
Preferred:
- CCEP - Cert Compliance & Ethics Prof Healthcare Compliance Association, Or
- CHC - Certified in Healthcare Compliance American Institute of Healthcare Compliance, Or
- CHC - Certified in Healthcare Compliance Compliance Certification Board (CCB)
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