Job Description

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.

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

The Director, Compliance Audit & Risk is responsible for overseeing all ongoing activities related to the development, implementation, and maintenance of Community's Audit Program. Oversee and manage efforts for the internal audit program that ensures the soundness of internal controls over key financial and operational processes, including IT General Controls. Responsible for oversight of the internal audit department staff and monitoring the Model Audit Rule (MAR) Compliance Program. Responsible for operational, compliance and claims audits to ensure Community's operations and processes are compliant with laws and regulations.

Must maintain open lines of communication with internal partners, regulators, vendors and other internal or external partners to assure collaborative working relationships. Provides direct support to the Chief Compliance Officer, focusing on the ongoing monitoring of control processes across all product areas and functions within the organization. Development of policies and procedures and corrective action plans to ensure that Community's Internal Audit, Risk Management and operational and compliance audit programs function efficiently and effectively.  Develop and maintain a professional team approach with both external and internal partners to achieve accurate results and the organizations strategic goals.

 QUALIFICATIONS:
 

  •  BA/BS degree (Masters preferred); CIA or CPA
  • Five years previous experience in Risk Management and/or Auditor role. Preferred experience in managed care organizations.
  • Two years management experience in a healthcare preferably managed care organizations.


OTHER SKILLS:

  •  Ability to maintain an attitude of independence and objectivity towards all internal and external partners.
  • Ability to organize tasks and work independently.
  •  Knowledge of statistics and sampling methodology.
  • Knowledge of billing (professional and facility) and coding (CPT, ICD-10, HCPCS, DRG)
  • Strong attention to details and deadlines. Strong communication skills.
  • Writing /Composing: Correspondence /Reports

Please be advised: Effective Wednesday, September 1st, 2021, with the exception of those who receive an approved exemption, all new hires must provide proof of vaccination against COVID-19 or receive the first dose of a COVID-19 vaccine by the second Friday of employment.

 

Application Instructions

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