Jobs Title: Compliance Auditor I
Company: Inland Empire Health Plans
Location: Rancho Cucamonga, CA
Salary: $43,264-55,161 per year
Contract Type: Permanent
Under the direction of the Audit Manager, the Compliance Auditor I is responsible for the auditing of IEHP internal departments, and external review of IEHP delegates, Pharmacy Benefit Manager (PBM) and other administrative contracts to ensure regulatory and contractual compliance requirements.
Major Functions (Duties and Responsibilities)
1. Audit internal departments to ensure compliance with the Seven (7) Elements of an Effective Compliance Program.
2. Conduct pre-contractual reviews of contracts and annual audits of IEHP’s delegates.
3. Perform risk assessments during audit planning and participate in the development of the audit scope, audit schedules, and deliverables.
4. Develop and maintain audit tools based on regulatory compliance with DHCS, DMHC and CMS requirements.
5. Document all compliance activities in the IEHP Compliance 360 database in accordance with department policies and/or workflows.
6. Prepare audit results, identify trends and make recommendations for improving business processes for presentation to the Audit & Monitoring Sub-Committee.
7. Validate the effective implementation of corrective action plans (CAPs) from internal departments & delegates to ensure appropriate completion and make necessary recommendations as needed for compliance.
8. Assist in the development and maintenance of P&Ps regarding auditing procedures.
9. Establish and maintain effective working relationships with others throughout the organization.
10. Coordinate, prepare and monitor special projects as needed.
2 – 4 years of managed care experience working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals. Experience with interpretation and/or implementation of Medicare, Medi-Cal managed care regulations is required.
Experience in a Health Care Operations, Pharmacy, Clinical environment preferred.
High School Diploma or GED required.
Bachelor’s degree from an accredited institution is preferred.
Pursuing, or attained, applicable audit or compliance designation (e.g. CPA, CIA, CFE, CISA, CHC, CHPC) or other related certification.
Drivers License Required
Candidate must possess an understanding of Medicare Advantage, Part D, and managed Medicaid and related regulations. Knowledge of healthcare-related computer systems/applications (MedHok, Compliance 360) helpful.
Candidate must also have experience working with firm deadlines, able to interpret and apply regulations. Must be organized, detail-oriented, able to exercise strong independent judgment. A team player. Must be able to work effectively with various internal departments/levels of management; external plan partners, IPAs and other external agencies.
Commitment to Team Culture
The IEHP team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence.
Starting Salary: $43,264.00 – $55,161.00
Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefits package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.