Alameda Alliance For Health Alameda , CA 94502
Posted 6 days ago
PRINCIPAL RESPONSIBILITIES:
Under the general direction of the Supervisor, Health Plan Audits,this position is responsible for supporting the Alameda Alliance for Health's (AAH) Compliance Program, with an emphasis on external/delegate auditing activities.
Principal responsibilities include:
Lead and/or coordinate external audits of AAH delegated entities to ensure compliance with regulatory and contractual requirements and controls.Recommend opportunities to strengthen the external audit control structure.
Coordinate the scheduling of delegated audits.
Conduct regularly scheduled and ad-hoc audits of delegated entities to ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices and documentation.
Develop and update audit tools to account for all current regulatory requirements.
Create and Implement the development of and the monitoring of corrective action plans resulting from delegated audits to mitigate risks.
Recommend opportunities to strengthen controls.
Develop, plan and coordinate preparatory "mock" audits, including reviews of policies & procedures, DMHC & DHCS technical assistance guides (TAGs), conduct question and answer sessions, and lead departments through audit prepatory measures as needed.
Assist in management of the AAH audit calendar.
Present audit findings to the Alliance Compliance Committee for review, discussion, and approval at least quarterly, or sooner if necessary.
Examine and analyze records, reports, operating practices and documentation.
Coordinate with external regulatory agencies and Alliance's internal departments on documentation requests and submissions, preparing for audit onsite visits, and corrective action plan responses.
Assist in the development of Alliance's policies and procedures and monitoring of the annual policy review process.
Train and assist various delegated entities in developing best practices in their operations in accordance with established policies and procedures.
Assist in reviewing policies for updating to include regulatory standards.
Maintain a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting publicly-funded managed care organizations and the Alliance.
Maintain knowledge of business products and related Alliance policies and procedures.
Research and interpret Knox-Keene Act, Title 22 and Department of Health Care Services (DHCS) regulations.
Monitor regulatory/compliance climate and escalate issues when necessary.
Complete other special projects and duties as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
PHYSICAL REQUIREMENTS
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
SALARY RANGE $80,040.08-$120,060.11 Annually
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.
Alameda Alliance For Health