Compliance Auditor (Healthcare) in Portland, Oregon - #67738 | VanderHouwen

Description

Job Id: 67738

Compliance Auditor (Healthcare)
The Compliance Auditor is responsible for planning and conducting internal and external audits for our client and its subcontractors, partners, and medical claims, as well as monitoring trends of non-compliance against established criteria such as policies and procedures, Oregon Administrative Rules, and federal laws and regulations.

This position is 100% remote.

Compliance Auditor (Healthcare) Responsibilities 
Analyzes audit results to determine the root cause of errors and recommends process improvements.
Reviews error trends to identify training opportunities. May provide education on regulatory compliance and follow up with corrective action activities under the guidance of the Compliance Officer.
Assists with development of annual audit plan, including risk assessment development and compilation of results, and presentation of the annual plan to appropriate committees and leadership for approval. Creates and maintains audit records, analytical reports, and track and trend audit program activities.
Helps evaluate the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to the appropriate execution of regulatory requirements and guidelines related to the organization’s integrity and compliance.
Monitors regulatory, legal, and industry developments and identifies opportunities for their application to the Compliance program.
Manages compliance program incident logs.
Maintains accurate, complete, and up-to-date compliance documents and records and produces for the Compliance Officer upon request.
Other duties as assigned.

Essential Department & Organizational Functions
Responsible for evaluating compliance to key operational, legal, and regulatory language within the Oregon Health Authority (OHA) contract, Oregon Administrative Rule, and Code of Federal Regulation.
Works to cultivate and develop inclusive and equitable services, and working relationships with diverse groups of employees, community partners, and community members.
Participates in the preparation and submission of regulatory and contract required deliverables.
Works closely with other departments, including Health Plan Operations and Compliance to assist with audits; including the External Quality Review (EQR), as needed.
Performs internal audit investigations and assists with fraud, waste, and abuse investigations throughout the health plan and compiles detailed reports with recommendations to the Compliance Officer.
Assists with the development of annual audit plans according to the annual risk assessment.
Proposes and implements process improvements.
Meets deadlines for completion of assigned responsibilities and projects.
Maintains agreed upon work schedule with punctual, regular, and predictable attendance.
Demonstrates cooperation and teamwork using a professional and respectful demeanor.
Provides cross-training on specific job responsibilities.
Meets identified goals that contribute to departmental goals.
Works collaboratively in a team and matrixed (cross-department) environment with a spirit of cooperation.
Respectfully takes direction from Supervisor.
Other duties as assigned.

Compliance Auditor (Healthcare) Qualifications
Required:
At least two (2) years of healthcare auditing experience. OR:
Any combination of education and experience that would qualify candidate for the position.

Preferred:
Five (5) years of healthcare auditing experience.
At least two (2) years of Healthcare Auditing experience in the Medicaid / Medicare realm.
Bachelor’s degree in Healthcare or related field.
Experience and knowledge in Health Plan Compliance and Auditing.
 
Certificates, Licenses and/or Registrations
Certified Professional Coder (CPC) or equivalent certification required.

Skills:
Excellent organizational skills including ability to handle multiple priorities and demands simultaneously in a dynamic work environment while maintaining high attention to detail and accuracy.
Ability to work independently, use sound judgment, anticipate next steps and be proactive as part of a diverse team within a Matrix or shared resources across departments work model.
Excellent computer skills, including Microsoft Windows, Word, Excel, and Outlook.
Excellent computer skills are needed with a strong proficiency in Excel and similar tools and the ability to effectively manipulate and organize complex data.
Curious, detail-oriented, and inquisitive mindset.
Organizational and time management skills, along with an ability to skillfully handle time- sensitive projects. Analytical, problem-solving, and decision-making skills to work through challenging and complex details.
High degree of integrity and confidentiality required for handling information that is personal and confidential. Strong written and verbal communication skills, including the ability to obtain information from others and deliver information in a concise, clear, and accurate manner.
Ability to work independently, when needed, and to use sound judgment, anticipate next steps and be proactive.
Ability to communicate both professionally and effectively in all forms of communication.
Ability to work in an environment with diverse individuals and groups.
Ability to remain flexible, positive, and adaptable.

Compensation: $77,600 – $90,700/year (DOE)

Meet VanderHouwen
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VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.

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