Compliance Auditor, Delegation - Community Health Choice
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
JOB SUMMARY: The Compliance Auditor, Delegation Oversight will assist with performing oversight of delegated entities, as well as other State and Federal Program assignments to ensure compliance with all applicable contractual, legal, and regulatory requirements. The primary responsibility of this role is to assist the Compliance Manager, Delegation Oversight in facilitating routine delegate auditing and monitoring activities. This will include audit planning, reviewing audit files during fieldwork, contributing ideas about compliance findings, and drafting audit reports. Additionally, this role will serve in support of the team with scheduling of meetings and documenting the delegation audit process.
Education/Specialized Training/Licensure: Bachelor's degree required; Prefer Healthcare Administration, Business, Political Science, Health Policy, or related discipline.
Work Experience : Two plus (2+) years of experience working in compliance, vendor oversight, audit, contracting, or quality management, within the Health Care industry.
Equipment Operated: Standard Office Equipment.
Above Average Verbal (Heavy Public Contact)
Exceptional Verbal (e.g., Public Speaking)
Writing /Composing (Correspondence / Reports )
Bachelor's Degree Major: BA/BS
Work Schedule: Flexible, Travel
Ability to maintain an attitude of independence and objectivity towards all internal and external partners.
Ability to read and understand contracts, laws, and regulations.
Aptitude to take initiative with strong personal accountability.
Resourceful in solving problems and maximizing resources.
Ability to work effectively with others, as well as on own.
Detail-oriented and ability to draw conclusions.
Basic knowledge of managed care, legislative and regulatory processes is required.