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Regulatory Audits and Governance Compliance Advisor III (Temp Only)

Company: TransReach Talent
Location: Los Angeles
Posted on: July 1, 2020

Job Description:

Manages all regulatory audits for the organization including but not limited to program, medical, data validation, financial. Ensures timely, accurate, and complete submission of responses to regulatory auditors. Develop, maintain, and report periodic status reports to Leadership Team and stakeholders pursuant to activities. Designs and conducts audit readiness assessments to determine gaps in compliance, determine opportunities for remediation and process improvement, and guide in implementation of the corrective actions. Leads and facilitates cross-functional work group meetings involving leadership and to ensure audit readiness. Proactively works with management team to improve organizational effectiveness on regulatory audits. Conducts ongoing monitoring through development of compliance key performance indicators (KPIs). Drives remediation efforts and provides internal and external stakeholders with recommendations to improve compliance in their areas. Manages the Internal Compliance Committee materials and the Compliance Department component of the Compliance and Quality Committee of the Board of Directors. Design and deploy regulatory audit training for both internal and external stakeholders. Perform other duties as assigned. Education Required Bachelor's Degree in Business Administration or Related Field In lieu of degree, equivalent education andor experience may be considered. Education Preferred Juris Doctor Degree or Doctor of Law Degree (J.D.) Experience Required At least 5 years of auditing experience (preferably in Appeals, Credentialing, Grievances, Quality Improvement, UM, and so forth) and developing audit tools in a managed care setting. Experienced in auditing or comparable managed healthcare product development or product management (preferably in Appeals, Credentialing, Grievances, Quality Improvement, UM, and so forth or Medicare AdvantageCal MediConnectMediCal product management experience) and or development of audit tools in a managed care setting. Working knowledge of Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services(CMS) and National Committee for Quality Assurance (NCQA) requirements is required Preferred Supervisory experience. Two or more years of Internal auditing experience for a health plan or healthcare system. Work experience in health plan, physician group, or hospital administration. At least 3 years of experience overseeing external regulatory audits. Skills Required Must possess a strong understanding of Medi-Cal and Medicare laws and regulations and other state programs. Highly developed analytical and critical thinking skills. Excellent written and oral communication skills are essential. Ability to manage multiple priorities and projects and meet deadlines. Demonstrated delivering training programs and making presentations to staff and providers. LicensesCertifications Required LicensesCertifications Preferred Certified HealthCare Compliance (CHC) Required Training Contact Details Mohan Krishna T +1-609-745-0599 e mohanTransReach.com

Keywords: TransReach Talent, Los Angeles , Regulatory Audits and Governance Compliance Advisor III (Temp Only), Accounting, Auditing , Los Angeles, California

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