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Compliance Auditor (US Healthcare Program)

at Convey Health Solutions
Published July 9, 2024
Expires July 24, 2024
Location 10th Floor, Robinsons Cybergate Plaza, EDSA Mandaluyong City, Philippines 1550, Mandaluyong City, Philippines
Category Others  
Job Type Full-time  

Description

The Compliance Auditor is responsible for planning and executing internal audits, and provides support to external audits. This position will evaluate operating and regulatory guidelines, policies and procedures, and reports negative results to management. As needed, the Auditor will utilize various databases, and spreadsheets to manage the audit process.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

  • Assist Compliance Manager in accessing Medicare program guidelines.
  • Evaluate process, policy, to ensure compliance with regulatory guidelines.
  • Act as an internal resource and subject matter expert on Medicare guidelines, providing regulatory
  • guidance and interpretation to business owners to ensure ongoing compliance and consistency.
  • Perform internal compliance audits on operational departments to ensure compliance with business
  • practices and regulatory guidelines.
  • Monitor calls for compliance
  • Develop internal reports, action or corrective action plans
  • Prepare and participate in internal/external compliance audits.
  • Participate in regular meetings with business owners.
  • Review reports or other documents to identify issues and trends.
  • Participate in the development of any applicable compliance training, education or communication
  • Review training, education and communications developed by other departments from compliance
  • prospective.
  • Maintain a working knowledge of relevant issues, laws and regulations.
  • Participate in ongoing education and training.
  • Perform regulatory research related to company operations
  • Communicate with coworkers, management, staff, customers, and others in a courteous and
  • professional manner.
  • Conform with and abide by all regulations, policies, work procedures and instructions

 

EDUCATION AND EXPERIENCE:

 

  • Bachelor’s degree preferred from an accredited college or university
  • Minimum of one (1) year experience in health care (Medicare Programs), insurance, compliance,
  • regulatory or law, with experience in legal research of regulatory issues and performing audits to
  • measure compliance with regulations or any equivalent combination of related training and
  • experience.
  • Experience in billing and enrollment also desired.

 

OTHER DUTIES AND RESPONSIBILITIES:

 

  • Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.
  • Responsible for participating in quality assurance, compliance and in-service and continuing education
  • activities as requested by Company.
  • Responsible for performing other duties and responsibilities as required.
  • Act, dress, and behave in a professional manner to reflect a positive image of the company.

 

 

KNOWLEDGE, SKILLS, and ABILITIES:

 

  • Knowledge of Medicare and Medicaid programs desirable.
  • Compliance, Auditing or Investigation certification desirable
  • Technical knowledge of legislation, rules and regulation governing the insurance industry.
  • Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulation.
  • Ability to define issues and risks collects data, establish facts and draw a valid conclusion.
  • Ability to communicate issues or data results in written form in an easily understandable fashion.
  • Require analytical skills to interpret data.
  • Respond promptly to customer needs; responds to requests for service and assistance and meets commitments.
  • Take responsibility for own actions, keeps commitments, and commits to long hours of work when necessary to reach goals.
  • Maintain confidentiality.
  • Gather and analyzes information skillfully; works well in-group problem solving situations.
  • Skill in communication and interpersonal skills sufficient to exchange or convey information and to receive work direction.
  • Ability to analyze data and prepare reports.
  • Ability to interact professionally and maintain effective working relationships with superiors, coworkers, customers, and others.
  • Ability to work in an environment with many interruptions.
  • Work efficiently in a stressful environment.
Employer questions
Your application will include the following questions:
  • What's your expected monthly basic salary?
  • How many years' experience do you have as a Compliance Auditor?
  • What's the highest level of Lean Six Sigma certification that you have completed?

Summary of role requirements:

  • Looking for candidates available to work:
    • Monday: Evening
    • Tuesday: Evening
    • Wednesday: Evening
    • Thursday: Evening
    • Friday: Evening
  • 2-3 years of relevant work experience required for this role
  • Working rights required for this role
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