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Sr., Compliance Auditor - PCHP

Date:  Jun 26, 2022
Location: 

Dallas, TX, US

Category:  Corporate and Professional Jobs
Job Type:  Day
Requisition ID:  637421

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.

 

Primary Purpose

Parkland Community Health Plan's (PCHP's) Senior Compliance Auditor is responsible for overseeing all compliance activities and requirements of Parkland Community Health Plan. Serves as the auditor-in-charge for the Compliance Department. Serves as a primary resource both internally and externally regarding compliance-related issues. Audits and analyzes the clinical and operational work processes, policies, and procedures to ensure compliance with all laws, regulations and guidelines with Federal and State programs. Identifies documents and presents any errors, irregularities, or findings. Serves on various interdisciplinary committees as assigned. 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 relevant experience, to include, two (2) years in a corporate compliance program or two (2) years in health plan and/or audit environment; and/or eight (8) years of healthcare compliance or regulatory experience.
  • Total experience must include three (3) years¿ auditing experience at a health plan, managed care organization, or healthcare audit consulting firm.
  • Experience with 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

Must be currently certified and in good standing or obtain certification within twenty-four (24) months of hire with one of the following:

 

Health Care Compliance Associate (HCCA) Compliance Certification Board (CCB) exams:

  • Certified in Healthcare Compliance (CHC)
  • Certified in Healthcare Research Compliance (CHRC)
  • Certified in Healthcare Privacy Compliance (CHPC)

 

-OR-

 

 American Health information Management Association (AHIMA):

  • Certified Coding Associate (CCA)
  • Certified Coding Specialist (CCS)
  • Certified Coding Specialist
  • Physician-Based (CCS-P)
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
  • Certified Documentation Improvement Practitioner (CDIP)
  • Certified Health Data Analyst (CHDA)
  • Certified in Healthcare Privacy and Security (CHPS)

 

 -OR-

 

The Institute of Internal Auditors (IIA):

  • Certified Internal Auditor (CIA)
  • Qualification in Internal Audit Leadership (QIAL)
  • Certification in Risk Management Assurance (CRMA)

 

-OR-

 

American Academy for Procedures Coders (AAPC):

  • Certified Procedure Coder (CPC)
  • Certified Outpatient Coder (COC)

 

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.
  • Must be able to write detailed reports of findings and recommendations. Must demonstrate an ability to review and interpret electronic medical record documentation.
  • 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.
  • Must be able to demonstrate knowledge input, extract, and analyze information using word processing, spreadsheet, and data base software.
  • High proficiency in Microsoft Excel, Word, and Access applications.

 

Responsibilities

  • Conducts assigned compliance reviews. Audits established clinical and operational processes, policies, and procedures to detect errors or irregularities and ensure compliance with all laws, regulations, and guidelines of Parkland Community Health Plan's (PCHP's), Federal and State programs.
  • Review to ensure that internal controls, such as polices/procedures, systems, training, and monitoring, etc., are present and functioning.
  • Serve as the as the auditor-in-charge by contributing expertise in reviewing compliance-related issues.
  • Researches regulations and determines the direction and approach of assigned compliance reviews and writes a corresponding methodology referencing source (TDI, HHSC, NCQA, CMS),
  • Conducts entrance meetings to discuss review methodology with auditees. Communicates with the auditees throughout the audit by the distribution of periodic status updates and interim meetings.
  • Documents review activities in automated work paper system. Prepares work papers and documents each step and validates all information. Using the work paper application, enters project related milestones, maintains project related data, and maintains an accounting of project time. Tracks and monitors work plan assignments.
  • Prepares a clear, concise audit report detailing the review findings, risks, and recommendations. Conducts meeting to present preliminary review findings to auditees, and to develop mutually agreed-upon recommendations. Incorporates management responses from the auditees which detail the specific steps they plan to take to implement the agreed upon recommendations and time frames. Conducts exit conference to present draft findings/report to auditees. Finalizes audit report for distribution.
  • Pro-actively performs follow-up reviews of areas with errors previously identified. Ensures that recommendations are implemented according to targeted action dates. If necessary, obtains current sampling and reviews to ensure that errors have decreased.
  • Assists in the compliance risk assessment process used in the development of the annual audit plan to ensure the plan meets PCHP’s needs.
  • Assists with investigations, documents, and reports suspected violations and irregularities to ensure prompt corrective action and/or resolution of the issue. Coordinates efforts with PCHP’s Corporate Compliance Charge and Reimbursement Integrity, Regulatory and Accreditation Services, Legal Affairs, and Patient Financial Services.
  • Maintains a positive relationship with departments throughout PCHP and outside contacts to ensure direct access, communication, and cooperation with planning, implementing, and monitoring compliance issues. - Serves as a resource both internally and externally regarding compliance-related issues. Serves on various interdisciplinary committees as assigned.
  • Assists in the development of compliance-related departmental policies and procedures (internal and external).
  • Conducts staff training and in-services related compliance functions as needed.

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

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