Compliance Monitoring & Auditing

Hi

Hope you are doing well!

Please find the job description below for a Manager, Compliance Monitoring & Auditing and let me know your thoughts.

Role: Manager, Compliance Monitoring & Auditing
Location: Bellaire, Texas-Hybrid
Duration: 12 MONTHS
Experience: 12+ year

Job Description:
The role involves managing, overseeing, monitoring, and conducting internal and external auditing and real-time monitoring activities related to the Health Plan's regulatory and contractual requirements. The position ensures compliance with federal and state regulations and provides guidance to develop an auditing and monitoring program.
Responsibilities:
Ensure ongoing compliance with federal and state regulations.
Provide guidance and tools to assist the Health Plan in developing an auditing and monitoring program.
Develop comprehensive audit tools to measure internal performance and performance of third parties.
Review and revise audit tools annually with feedback from Senior Management.
Align compliance oversight and reporting with regulatory and contractual requirements.
Mandatory Skills:
Knowledge of healthcare regulatory environment, including CMS, HIPAA, and HITECH regulations.
Technical knowledge related to personal computers and business information systems.
Ability to analyze data and situations and formulate practical solutions.
Proficiency in computer word processing, spreadsheet, and graphics software applications.
Experience in provider contract, benefit, fee schedule configuration.
Demonstrated experience in effective management of resources and inventory management.
Bachelor's Degree and 5 years of progressive compliance, auditing, healthcare, and/or legal experience.
Nice-to-Have Skills:
Tapestry experience.
Epic Certifications and Experience in Claims, Contracts, Benefits.
Claims adjudication experience.
Experience in applying regulatory medical coding guidelines.
Experience in reporting and business strategy.