Delegation Oversight Compliance Auditor II

Job Summary

The Delegation Oversight Compliance Auditor II ensures delegates are compliant with all Product Lines contractual, state, and federal regulatory, and accreditation requirements. This position serves as a resource to internal business units and external entities by providing working knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements.  The position conducts audits, investigates, assists with coordination and management of teams and workgroups, creates project documentation and workflows, drafts presentations, audits, and monitors performance standards.

Duties

Analyzes and interprets contractual, state, and federal regulatory, and accreditation requirements. Stays abreast of changes in healthcare regulations, laws, and industry standards; analyzes regulatory developments and assesses their impact on the organization.

Participates in and conducts compliance functions, including, but not limited to, develops compliance audit tools and validates implementation of new requirements and corrective action plans.

Collaborates with cross-functional teams, including Legal, Compliance, Quality Assurance, and Operations, to address compliance-related challenges and implement effective solutions. Works with internal business units to prepare reports for distribution to internal Committees and external entities.

Works with internal business units and/or external entities to correct performance deficiencies.

Delivers regulatory trainings for internal business units and/or external entities.

Facilitates and participates in compliance related projects.

Assists in the development, review, and updating of policies, procedures, guidelines compliance work plans, to ensure alignment with regulatory requirements and industry best practices.

Conducts audits of L.A. Care subcontracted providers including, but not limited to, Participating Physician Groups, Plan Partners, and Specialty Health Plans/Vendors.

Updates existing audit tools based on regulatory changes.

Leads entrance and exit conferences, and technical calls with delegates.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

A least 3 years of audit experience in compliance, delegation oversight, or audit within the healthcare industry.

Demonstrated experience in delivering training programs and making presentations to internal staff and providers.

Skills

Required:

Knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements.

Highly developed analytical and critical thinking skills

Ability to manage multiple priorities, projects and meet deadlines.

Excellent verbal and written communication skills.

Proficient in Microsoft Office, Excel, and PowerPoint.

Knowledge of policies and procedures. 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information