Manager Compliance Monitoring & Auditing

Job Title: Manager Compliance Monitoring & Auditing
Location: Houston, TX 77401 (Remote)
Duration: 3+ Months (Possible extension)

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) 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 and must be reviewed and/or revised at least once annually.

Required - 

REMOTE!! : Please do not submit candidates from Ohio, Wyoming, Washington, North Dakota, California, New York.

-    They do not have to have tapestry experience; but yes to either benefit, contracts, or fee schedules 
-    Types of roles that could have experience
-    Payment integrity, Revenue Cycle Management, Claims (w/ config experience)
-    Regulatory knowledge (they do not need to be certified

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.

Education:

• Bachelor's Degree
• 5 years progressive compliance, auditing, healthcare, and/or legal experience

Preferred:

• CCEP - Cert Compliance & Ethics Prof Healthcare Compliance Association, OR