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Audit and Delegation Specialist, South San Francisco, CA


Organization: Health Plan of San Mateo
Category: Professional
Location: South San Francisco, CA
Date Job Posted: February 5, 2020
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AUDIT AND DELEGATION SPECIALIST

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Audit and Delegation Specialist. Responsible for quality of internal audit efforts, including delegated entity oversight. Oversees corrective action plan (CAP) management process, ensuring syncing of activities between internal and external audits. Ensures validation and verification activities reflect organizational risks; develops and implements projects, objectives and/or goals to achieve department and organizational needs.

The essential duties and responsibilities will include the following:

  • Promotes department drive for continuous quality improvement by creating, analyzing and critiquing activities for the internal audit plan and delegation oversight.
  • Ensures appropriate oversight of high risk operational functions internal to the organization and with delegated entities by analyzes internal audit plan performance, identifying areas of improvement; adjusts audit plan, processes and tools as necessary to remediate risk, reduce administrative burden and duplicative effort.
  • Ensures audit tools, procedures, and processes reflect current regulatory standards and organizational needs.
  • Engages with business owners to review internal audit performance and processes; solicits feedback and ensures department responses are appropriate to needs, concerns and risks.
  • Responsible for management of delegation oversight activities, ensuring delegated entities are audited according to the risk associated with delegated activities; ensures routine reports are received, analyzed and disseminated across the organization to the appropriate parties for review and additional action.
  • Leads audit efforts with delegated entities by functioning as plan representative; ensures staff and resource needs for audits of delegated entities is obtained and appropriately deployed.
  • Supports the Compliance Investigator by overseeing the CAP management process for internal activities; collaborates with the Specialist III to ensure Leadership has adequate insight into overall organizational compliance performance.
  • Collaborates with department staff, including but not limited to the Compliance Program Manager and Compliance Specialist III to ensure department goals, objectives and initiatives promote efficient audits geared towards reducing external audit findings.
  • Conducts and supports audits scheduled and assigned from the internal audit work plan.
  • Supports external audit activities by distributing workload among department staff to ensure timely return of data and files requested by regulatory agencies.
  • Supports and when directed, leads HPSM’s Audit Work Group and related activities.
  • Perform other duties as assigned

Requirements

Education and Experience:

  • Bachelor’s Degree in Business Administration, Health Care Management or Public Policy required.
  • Minimum four (4) years of managed care or health care experience preferably with Medicare/Medi-Cal experience
  • Experience with quality improvement/process improvement techniques preferred.
  • Previous project/program management experience preferred.

Knowledge of:

  • Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint
  • Proficiency with project management software, including Microsoft Project, Confluence or similar tools
  • Internal auditing, quality assurance, and/or quality improvement processes
  • Change management, process improvement and redesign
  • Knowledge of accrediting/regulatory body requirements

Ability to:

  • Work cooperatively with others.
  • Work as part of a team and support team decisions.
  • Communicate effectively, both verbally and in writing.
  • Adapt to changes in requirements/priorities for daily and specialized tasks
  • Demonstrate strong analytical and research skills
  • Communicate effectively, orally and in writing

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Expectations may not be considered.


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