Mgr Compliance Monitoring & Auditing Ref 2160039824

We are seeking a dedicated Manager of Compliance Monitoring & Auditing with at least 5 years of experience with a children's hospital. It is a remote 13-week contract with potential to hire.

About the Role

Must have a bachelor's degree in a related field and have experience with progressive compliance, auditing, provider contracts, benefits, and fee schedule configuration.

Responsibilities

• 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.
• 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.
• Ensure ongoing compliance with federal and state regulations.
• 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.

Qualifications

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

Required Skills

• Knowledge of general business systems and their related control structures.
• Extensive knowledge of the 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.
• EPIC Tapestry experience (preferred)

Preferred Skills

• Mandatory provider contract, benefit, fee schedule configuration experience.