Centers Plan for Healthy Living

Compliance Auditor

US-NY-Staten Island
7 months ago
ID
2017-1153
# of Openings
1
Category
Compliance

Overview

The Compliance Auditor works with the Regulatory/Compliance Department team to ensure health plan compliance. Under the direction of the Chief Compliance Officer, the Compliance Auditor is responsible for working independently on assigned projects and tasks. The Compliance Auditor demonstrates knowledge of Medicare (Parts C and D) and Managed Medicaid regulations and compliance monitoring activities to effectively perform duties that support the company compliance program. The Compliance Auditor initiates and performs audits and investigations of health plan operations in support of compliance.

Responsibilities

• Review and investigate complaints and reports of non-compliance related to health plan compliance received through regulatory agencies, internal departments, and business partners
• Serve as a liaison between the Compliance department and regulatory agencies for complaint-related correspondence
• Monitor and prepare reports on compliance activities and other topics
• Complete compliance audits and monitoring of various health plan operations
• Prepare audit and investigation reports of findings and observations that identify, in detail, areas of non-compliance and risk areas for non-compliance
• Review policies marketing materials for compliance with CMS and NYSDOH regulations
• Submit marketing materials for review and approval by CMS and NYSDOH
• Document all compliance activities in accordance with department polices and/or workflows

Qualifications

• Bachelor's Degree required
• Four or more years of experience in compliance-related matters in the health care industry
• Understanding of Medicare Advantage, Part D, and managed Medicaid and regulations required
• Knowledge of medical coding and payment necessary

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