| Description | Job Title: Manager - Compliance Monitoring & Auditing (36350037) Location: Bellaire TX 77401 / Remote Job Type: 3 Months Contract Shift: Remote Duties: Manage oversee monitor and conduct internal and external auditing and real-time monitoring activities related to the Health Plan's regulatory and contractual requirements in accordance with the Compliance Program as well as associated compliance oversight and reporting to align with regulatory and contractual requirements in accordance with the Compliance Program and with HHSC TDI NCQA and Health Plan Senior Management. Ensure ongoing compliance with federal and state regulations and provide guidance and tools to assist the Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third parties (i.e. subcontractors) against Health Plan metrics policies regulations and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from Senior Management and must be reviewed and/or revised at least once annually. REMOTE!! - They do not have to have tapestry experience but yes to either benefit contracts or fee schedules - Types of roles that could have experience - Payment integrity Revenue Cycle Management Claims (w/ config experience) - Regulatory knowledge (they do not need to be certified Skills: • Knowledge of general business systems and their related control structures extensive knowledge healthcare regulatory environment including CMS HIPAA and HITECH regulations. Must have technical knowledge related to personal computers and business information systems and related applications. Ability to analyze data and situations determine errors and potential problems arising from the analyses and formulate practical and workable solutions to the problems identified. Must be able to utilize computer word processing spreadsheet and graphics software applications. Must be able to work effectively with all levels of management and be able to write clearly and effectively. Education: Required- Bachelor's Degree Preferred- CCEP - Cert Compliance & Ethics Prof Healthcare Compliance Association Or CHC - Certified in Healthcare Compliance American Institute of Healthcare Compliance Or CHC - Certified in Healthcare Compliance Compliance Certification Board (CCB) Required- 5 years progressive compliance auditing healthcare and/or legal experience Job Type: Contract Pay: $46.54 - $70.00 per hour Application Question(s): If interested please leave your email contact number and best time to reach you Experience: compliance auditing healthcare and/or legal : 5 years (Preferred) Payment integrity Revenue Cycle Management Claims : 3 years (Preferred) benefit contracts or fee schedules : 2 years (Preferred) License/Certification: CCEP/CHC (Preferred) Work Location: Remote |