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Compliance Auditor III in Phoenix, AZ at HSAG

Date Posted: 7/6/2018

Job Snapshot

Job Description

SUMMARY

Works independently as a lead or team member for compliance reviews and other external quality review organization (EQRO) activities; Assumes leadership in the development of the compliance review tool, desk review tool, onsite interview questions, onsite document reviews and report writing. Proficient on all compliance review standards. Coordinates project initiation; client relations and project planning. Competently represents the director/executive director in all EQRO activities.

ESSENTIAL COMPETENCIES, DUTIES AND RESPONSIBILITIES

  • Research, interpret and apply state contract requirements.
  • Research, interpret and apply the Centers for Medicare & Medicaid Services (CMS) and state rules and regulations to external quality review (EQR) work.
  • Using statutes, regulations, and state contracts, develop compliance review tools for external quality review work.
  • Conduct compliance reviews from initiation to completion, as a team member and/or team leader, performing a review of all compliance review standards.
  • Draft complete compliance review report.
  • Conduct and document environmental scans of state best practices related to Medicaid and EQRO activities and system reform.
  • Conduct literature searches and research on topics for use in evaluating EQRO projects.
  • Provide technical assistance to state agencies and their contracted managed care entities related to project and review activities, in particular, monitoring and oversight issues.
  • Draft responses to request for proposals (RFPs).
  • Draft monthly/quarterly summary reports and ad hoc reports.
  • Conduct focused studies.
  • Write technical reports.

PLEASE NOTE: A 30-minute writing exercise will be conducted for all qualified candidates.

Job Requirements

EDUCATION AND/OR EXPERIENCE

  • Master's degree in a healthcare-related field, or a bachelor’s degree, and five years of experience in compliance, or an equivalent combination of education and experience.
  • Managed care experience.
  • Minimum five years of program evaluation/review experience in government, hospital, health plan, state Medicaid agency or other healthcare related field.

OTHER QUALIFICATIONS

  • Quality improvement review experience preferred.
  • Experienced with Windows environment.
  • Excellent oral and written communication skills.
  • Works well in a team environment and independently.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

DISCLAIMER

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, work load, rush jobs requiring non-regular work hours, or technological developments).

HSAG is an EEO Employer of Veterans protected under Section 4212.

If you have special needs and require assistance completing our employment application process, please feel free to contact us.

EOE M/F/Vet/Disability.

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