Delegation Oversight Auditor I
Camarillo, CA Camarillo, CA Full-time Full-time $74,000 - $110,000 a year $74,000 - $110,000 a year CA salary range posted.
Please note:
Salary range will vary for out of state remote work.
Gold Coast Health Plan will not sponsor applicants for work visas POSITION SUMMARY Under the general direction of the Director, Compliance, the Delegation Oversight Auditor, leads, coordinates, and participates in all delegation oversight audits of Gold Coast Health Plan's vendors, service providers and delegated subcontracted providers according to regulatory and contractual requirements.
In support of the Director, Compliance, assists in the liaison role between the subcontracted providers in the delegation oversight process.
The position will also lead the delegation audit process, develop reports regarding audits, and analyze, track and trend audit findings.
A second core function of the position is to support the Gold Coast Health Plan's compliance department.
The focus in this area is to convey information to and problem-solve issues for internal and external stakeholders.
Provide guidance on regulatory requirements and reporting.
Assist with regulatory audit(s) preparation and coordination.
The incumbent performs a variety of administrative duties that require a degree of analytical, organizational, and technical skills and exercises a level of discretion and judgment appropriate for the scope of the position.
ESSENTIAL FUNCTIONS Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily.
Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s) Lead/Coordinate the scheduling of delegation oversight audits.
Provide administrative support to Health Plan staff in the acquisition and distribution of files for audit.
Participate in the audit process.
Assist Health Plan staff in the development and routing of the audit findings.
Aggregate and analyze audit findings into a reportable format for management use.
Maintain accurate recordkeeping of all delegation oversight audits and ensure all deadlines are met.
Assist in the revision of delegation oversight audit tools in accordance with standards set by ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.
Participates in the Joint Operations Committee (JOC) meetings.
Participates in the Compliance Committee meeting.
Assist in the Development & Implementation of the Delegation Oversight Program.
Assist with complex tasks relative to Delegation Oversight & Compliance.
POSITION QUALIFICATIONS Competency Statement(s) Analytical Skills - Ability to use thinking and reasoning to solve a problem.
Technical Aptitude - Ability to comprehend complex technical topics and specialized information.
Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.
Communication, Written - Ability to communicate in writing clearly and concisely.
Relationship Building - Ability to effectively build relationships with customers and co-workers.
Claims Auditing - Extensive background in claims operations in a Health Plan, preferably in claims auditing.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Judgment - The ability to formulate a sound decision using the available information.
Communication, Oral - Ability to communicate effectively with others using the spoken word.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
SKILLS & ABILITIES Education:
Bachelor's Degree (four-year college or technical school) Required.
Field of Study:
Business, Health Science, Managed Care
Experience:
3 plus years of experience in an audit, compliance or delegation oversight role, preferably in a managed care environment.
5 plus years of experience in claims.
Computer Skills:
Demonstrated proficiency included in the MS Office products, Word, Excel, Access and PowerPoint Certifications & Licenses:
A valid and current California Driver's License and Insurance Other Requirements:
Demonstrated effective general writing skills and business report writing skills.
Ability to establish, nurture and maintain strong and effective working relationships with the GCHP and Delegated Entity staff.
Ability to maintain detailed and accurate records, follow oral and written directions, prepare written agendas, and transcribe minutes.
Ability to operate a keyboard and sit for long periods; ability to read close-up and do close-up work Ability to perform repetitive motion (keyboard); writing (notetaking).
Ability to hear normal speech, hear and talk on telephone.
Ability to think and work effectively under pressure; Ability to deal with public contact.
Decision making, concentration.
Lead/Coordinate the scheduling of delegation oversight audits.
Provide administrative support to Health Plan staff in the acquisition and distribution of files for audit.
Participate in the audit process.
Assist Health Plan staff in the development and routing of the audit findings.
Aggregate and analyze audit findings into a reportable format for management use.
Maintain accurate recordkeeping of all delegation oversight audits and ensure all deadlines are met.
Assist in the revision of delegation oversight audit tools in accordance with standards set by ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.
Participates in the Joint Operations Committee (JOC) meetings.
Participates in the Compliance Committee meeting.
Assist in the Development & Implementation of the Delegation Oversight Program.
Assist with complex tasks relative to Delegation Oversight & Compliance.
Analytical Skills - Ability to use thinking and reasoning to solve a problem.
Technical Aptitude - Ability to comprehend complex technical topics and specialized information.
Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.
Communication, Written - Ability to communicate in writing clearly and concisely.
Relationship Building - Ability to effectively build relationships with customers and co-workers.
Claims Auditing - Extensive background in claims operations in a Health Plan, preferably in claims auditing.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Judgment - The ability to formulate a sound decision using the available information.
Communication, Oral - Ability to communicate effectively with others using the spoken word.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Please note:
Salary range will vary for out of state remote work.
Gold Coast Health Plan will not sponsor applicants for work visas POSITION SUMMARY Under the general direction of the Director, Compliance, the Delegation Oversight Auditor, leads, coordinates, and participates in all delegation oversight audits of Gold Coast Health Plan's vendors, service providers and delegated subcontracted providers according to regulatory and contractual requirements.
In support of the Director, Compliance, assists in the liaison role between the subcontracted providers in the delegation oversight process.
The position will also lead the delegation audit process, develop reports regarding audits, and analyze, track and trend audit findings.
A second core function of the position is to support the Gold Coast Health Plan's compliance department.
The focus in this area is to convey information to and problem-solve issues for internal and external stakeholders.
Provide guidance on regulatory requirements and reporting.
Assist with regulatory audit(s) preparation and coordination.
The incumbent performs a variety of administrative duties that require a degree of analytical, organizational, and technical skills and exercises a level of discretion and judgment appropriate for the scope of the position.
ESSENTIAL FUNCTIONS Reasonable Accommodations Statement To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily.
Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s) Lead/Coordinate the scheduling of delegation oversight audits.
Provide administrative support to Health Plan staff in the acquisition and distribution of files for audit.
Participate in the audit process.
Assist Health Plan staff in the development and routing of the audit findings.
Aggregate and analyze audit findings into a reportable format for management use.
Maintain accurate recordkeeping of all delegation oversight audits and ensure all deadlines are met.
Assist in the revision of delegation oversight audit tools in accordance with standards set by ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.
Participates in the Joint Operations Committee (JOC) meetings.
Participates in the Compliance Committee meeting.
Assist in the Development & Implementation of the Delegation Oversight Program.
Assist with complex tasks relative to Delegation Oversight & Compliance.
POSITION QUALIFICATIONS Competency Statement(s) Analytical Skills - Ability to use thinking and reasoning to solve a problem.
Technical Aptitude - Ability to comprehend complex technical topics and specialized information.
Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.
Communication, Written - Ability to communicate in writing clearly and concisely.
Relationship Building - Ability to effectively build relationships with customers and co-workers.
Claims Auditing - Extensive background in claims operations in a Health Plan, preferably in claims auditing.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Judgment - The ability to formulate a sound decision using the available information.
Communication, Oral - Ability to communicate effectively with others using the spoken word.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
SKILLS & ABILITIES Education:
Bachelor's Degree (four-year college or technical school) Required.
Field of Study:
Business, Health Science, Managed Care
Experience:
3 plus years of experience in an audit, compliance or delegation oversight role, preferably in a managed care environment.
5 plus years of experience in claims.
Computer Skills:
Demonstrated proficiency included in the MS Office products, Word, Excel, Access and PowerPoint Certifications & Licenses:
A valid and current California Driver's License and Insurance Other Requirements:
Demonstrated effective general writing skills and business report writing skills.
Ability to establish, nurture and maintain strong and effective working relationships with the GCHP and Delegated Entity staff.
Ability to maintain detailed and accurate records, follow oral and written directions, prepare written agendas, and transcribe minutes.
Ability to operate a keyboard and sit for long periods; ability to read close-up and do close-up work Ability to perform repetitive motion (keyboard); writing (notetaking).
Ability to hear normal speech, hear and talk on telephone.
Ability to think and work effectively under pressure; Ability to deal with public contact.
Decision making, concentration.
Lead/Coordinate the scheduling of delegation oversight audits.
Provide administrative support to Health Plan staff in the acquisition and distribution of files for audit.
Participate in the audit process.
Assist Health Plan staff in the development and routing of the audit findings.
Aggregate and analyze audit findings into a reportable format for management use.
Maintain accurate recordkeeping of all delegation oversight audits and ensure all deadlines are met.
Assist in the revision of delegation oversight audit tools in accordance with standards set by ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.
Participates in the Joint Operations Committee (JOC) meetings.
Participates in the Compliance Committee meeting.
Assist in the Development & Implementation of the Delegation Oversight Program.
Assist with complex tasks relative to Delegation Oversight & Compliance.
Analytical Skills - Ability to use thinking and reasoning to solve a problem.
Technical Aptitude - Ability to comprehend complex technical topics and specialized information.
Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.
Communication, Written - Ability to communicate in writing clearly and concisely.
Relationship Building - Ability to effectively build relationships with customers and co-workers.
Claims Auditing - Extensive background in claims operations in a Health Plan, preferably in claims auditing.
Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
Judgment - The ability to formulate a sound decision using the available information.
Communication, Oral - Ability to communicate effectively with others using the spoken word.
Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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