Compliance Auditor II

Key Qualifications

• Demonstrated understanding of audit standards and requirements, statistical data interpretation and applicability, risk assessment and control environments, audit theory and processes, and of the professional practice standards of internal auditing
• Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic health care environment
• Proficient knowledge of CMS Program Audit Protocols, DHCS Technical Assistance Guides, and DMHC Technical Assistance Guides
• Knowledge of regulatory research and regulations that apply to California Managed Care Health Plans
• Possess strong written and verbal communication skills, including a strong business writing aptitude
• Possess strong problem solving and creative thinking skills and the ability to reprioritize workload as needed
• Must be detail oriented, self-directed, and work with minimal supervision, both independently and in teams
• Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail
• Proficient in Microsoft applications (Word, Excel, PowerPoint, Outlook, etc.). Advanced skills in MS Excel preferred
• Effective in a consulting role with the ability to become a trusted advisor
• Able to maintain excellent interpersonal relationships within the department and at all levels of the organization
• Able to organize thoughts and data into well-organized communications and reports

Requirements

• Minimum or five (5) or more years in managed care operations required, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, Delegation Oversight, Quality Management, Care Management, and/or Grievances and Appeals
• Demonstrated experience, at a professional level, in an audit role
• Experience with interpretation and/or implementation of California managed care regulations
• Two (2) years of audit or quality assurance/quality improvement experience required
• In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position

Benefits

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance