Compliance Auditor

About Us Community Health Plan of Imperial Valley (CHPIV) is committed to improving the health and well-being of our community by offering accessible, high-quality, and culturally sensitive healthcare services. We are a local health plan dedicated to making a positive impact through education, outreach, and innovative care. The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards. About The Role Our new Compliance Auditor will do the following: Evaluate process compliance and operational workflows for internal and delegated functionsIdentify systemic issues and contribute to corrective action planningMonitor regulatory metrics and reporting to committeesConduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectivenessReview and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materialsAssess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligationsIdentify gaps in documentation, workflows, and performance that could result in audit findings or compliance risksMonitor corrective action plans and validate the resolution of findings to ensure sustained complianceSupport enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validationCollaborate with internal departments and external delegates to ensure alignment and operational consistency About Our Next Team Member Our new Compliance Auditor will have the following: Bachelor’s degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degreeMinimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environmentFamiliarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS)Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance servicesDemonstrated ability to review and interpret policies, procedures, and operational workflowsExcellent organizational, analytical, and time management skills with the ability to manage multiple prioritiesStrong written and verbal communication skills, including the ability to draft audit findings and compliance reportsProficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar toolsAbility to work independently and collaboratively in a fast-paced, deadline-driven environment Our commitment to you A competitive salary of $80,000-$100,000/ yearHealth, dental, and vision insurance that is paid 85% for you and your familyPaid life and disability insuranceA retirement plan with a generous matchPaid time offA chance to make a real difference in the Imperial Valley community We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Powered by JazzHR CpSoWNrAjB