Manager, Compliance Monitoring & Auditing

Position:
Manager, Compliance Monitoring & Auditing

Talent Area:
Professional - Non-Clinical

Full/Part Time:
Full time

Location:

Houston, TX, US

Department:
Controls & Compliance

Shift: 8a-5p Monday-Friday

Job

We’re looking for a Manager of Compliance Monitoring & Auditing, someone who’s ready to grow with our company. In this position you will 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 must be reviewed and/or revised at least once annually.
• See to the Compliance Department’s accurate and complete auditing documentation, monitoring initiatives, compliance‑based education, and correction of action plans. Analyze audit results and summarize areas of improvement needed. Review and update targeted training and educational materials that address deficiencies indicated by the auditing and monitoring program. Assist the Compliance Department with the issuance and management of corrective action plans related to auditing and monitoring indicators.
  
  Track and trend audit and monitor results. Maintain all auditing and monitoring records in accordance with record retention policy.
• Manage and develop the monitoring and auditing team within the Compliance Department.
• Monitor compliance activities using appropriate monitoring tools and techniques (Hotline, department interviews, committees, direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues, as appropriate. Report monitoring activities to senior leadership and governance committees as appropriate.
• Maintain ongoing monitoring activities using appropriate monitoring tools and techniques (Hotline, department interviews, committees, direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues, as appropriate. Include monitoring activities in the quarterly audit report.
• Develop and maintain an effective awareness and education program to ensure workforce knowledge of corporate compliance (including billing compliance, CMS regulations, HIPAA and HITECH regulations, Texas Medicaid rules) by preparing and administering articles, course content for required education initiatives and providing guidance to workforce. Assist with the development, implementation and training of policies and procedures for billing compliance programs (HIPAA, HITECH, CMS, The Joint Commission, acceptance of gifts, conflicts of interest, billing and documentation).

• Bachelors degree required
• 5 years progressive compliance, auditing, healthcare, and/or legal experience required

• CIA – Certified Internal Auditor, The Institute of Internal Auditors
• CPMA – Certified Professional Medical Auditor, American Academy of Professional Coders
• CHCRA – Certified Healthcare Risk Auditor, Association of Health Care Auditors and Educators
• CHA – Auditing for Compliance, American Institute of Healthcare Compliance

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children’s Health Insurance Program (CHIP) to pregnant women, teens, children and…