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.
• 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.
Required- Bachelor's Degree
Preferred- 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
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