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Delegation Overst Auditor PCHP

Date:  Apr 14, 2021
Location: 

Dallas, TX, US

Category:  Corporate and Professional Jobs
Shift Type:  Day
Requisition ID:  452341

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Disclaimer

The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job.

 

Primary Purpose

Parkland Community Health Plan’s (PCHP’s) Delegation Oversight Auditor is responsible for managing and overseeing all compliance activities and requirements of Parkland Community Health Plan delegated sub-contractors. Ensures compliance with all state and federal regulatory and contract requirements.

 

Minimum Specifications

 

Education

 

Bachelor’s degree.

 

Master’s degree in Healthcare Administration, Business Administration or related field is preferred.

 

 

Experience

 

Six (6) years of regulatory compliance and leadership experience managing projects in a large organizational setting.

 

Three (3) years of auditing experience at a health plan, managed care organization, or healthcare audit consulting firm.

 

Experience with delegation oversight, audit, monitoring and managing regulatory issues.

 

 

Equivalent Education and/or Experience

 

May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.

 

 

Certification/Registration/Licensure

 

 

Required Tests for Placement

 

 

Skills or Special Abilities

 

Knowledge of Medicaid Managed Care and health plan administration.

 

Ability to use problem solving skills and interpret statistics to systematically analyze problems, draw relevant conclusions and devise appropriate plan of action.

 

Experience providing highly complex analysis, defining efficiencies in relation to compliance programs and internal controls.

 

Development of audit tools and methodology for pulling random samples to conduct audit work plans.

 

Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement (TDI, HHSC, NCQA, CMS)

 

Strong analytical ability with attention to detail.

 

Excellent verbal and written communication skills. Must be able to write professional audit reports.

 

Ability to manage multiple priorities simultaneously and meet deadlines.

 

In-depth knowledge of health plan compliance, operations, standards, policies and procedures.

 

General knowledge of a broad spectrum of health plan laws and regulations.

 

Ability to evaluate complex health plan compliance issues, seek additional guidance when necessary and make appropriate recommendations.

 

High proficiency in Microsoft Excel, Word and Access applications.

 

Responsibilities

 

Responsible for performing regulatory/contractual delegation oversight control audits to ensure compliance with Federal and State regulatory agencies. Assures compliance to external specifications and standards. Conducts comprehensive regulatory reviews using a standard audit model.

 

Leads delegation oversight activities for PCHP in accordance with state and federal guidelines.

 

Develops, implements, and maintains the Delegation Oversight Program and audit plan to ensure compliance with all internal, external, regulatory and accreditation requirements.

 

Conducts pre-delegation and annual audits for new and existing delegated entities ensuring that the entity continues to perform the delegated activities.

 

Conducts extensive investigation, critical thinking to understand root cause of problems. Problems span a wide range of difficult and unique issues across functions and/or businesses.

 

Chairs the Delegation Oversight Committee.

 

Evaluates the effectiveness of delegated vendor compliance programs and related policies and procedures designed to promote legal and ethical compliance.

 

Prepare professional written reports of audit findings and recommendations for corrective action.

 

Create and maintain audit workpapers and records in accordance with department record retention policies and regulatory requirements.

 

Present audit findings and recommendations to management and the Delegation Oversight Committee.

 

Act as a liaison and resource to the delegated entities regarding contract and regulatory requirements, as well as the communication of new or revised requirements.

 

Coordinates resources with internal teams and legal counsel as needed to resolve issues related to delegation oversight functions and contracts.

 

Acts as primary liaison and resource for PCHP with all delegated subcontractors.

 

Stays current on all delegation oversight issues and regulatory changes and transfers knowledge to internal and external stakeholders as needed.

 

Conducts staff training and in-services related to delegation oversight functions as needed.

 

Communicates, collaborates and cooperates with internal and external stakeholders.

 

 

Job Accountabilities

 

  1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
  2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.

 

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.


Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth

Job Segment: Patient Care, Medicaid, Healthcare Administration, Public Health, Healthcare