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Compliance Auditor

Company: GlobalHealth, Inc.
Location: Oklahoma City
Posted on: February 24, 2021

Job Description:

WHO WE ARE:As an industry leader, GlobalHealth is an Oklahoma-Based health insurer covering individuals in all 77 counties. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company - we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning. HOW WILL THIS ROLE ADD VALUE TO THE ORGANIZATION?The successful candidate will be responsible for completing compliance audits in accordance with the GlobalHealth Compliance Plan. This includes, but is not limited to: (1) defining the audit purpose, scope, and methodology used; (2) conducting entrance conferences to explain the audit; (3) obtaining the necessary information/data necessary to conduct the audit; (3) drafting written reports that explain the rule, regulation or policy being audited and the audit findings; (4) making recommendations for corrective/remedial action; (5) timely communicating significant obstacles or immediate concerns to manager; and (6) presenting findings and recommendations to stakeholders through exit conferences. ESSENTIAL JOB FUNCTIONS:

  • Conduct compliance audits in accordance with the compliance audit work plan and department policies and procedures. Participate in the development of the annual audit workplan and quarterly goals.
  • Manage time efficiently to ensure audits and written reports are completed timely.
  • Prepare professional written reports of audit findings and recommendations for corrective action.
  • Create and maintain audit workpapers and records in accordance with department record retention policies and regulatory requirements.
  • Present audit findings and recommendations to management and/or subcommittees/workgroups.
  • Other projects and responsibilities as assigned. EDUCATION AND EXPERIENCE:
    • Bachelor's Degree required.
    • Minimum three (3) years' auditing experience at a health system, managed care organization, or healthcare audit consulting firm. Experience in auditing medical billing, coding, or claims processing strongly preferred.
    • Working knowledge of the Medicare Advantage Program.
    • Relevant certification preferred (e.g., CPC, RHIA, CIA, CHIAP, CHC) KNOWLEDGE, SKILLS AND ABILITIES:
      • Inquisitive mind with ability to spot issues or discrepancies.
      • Strong analytical ability with attention to detail.
      • Excellent verbal and written communication skills. Must be able to write professional audit reports.
      • Excellent computer skills (MS-Word, Excel, Outlook, etc.) with ability to utilize analytical and statistical software tools. Knowledge of claims/billing systems (e.g., EPIC, etc.) a plus.
      • Ability to manage multiple priorities simultaneously and meet deadlines.
      • Ability to maintain a high-level of confidentiality. WORK ENVIRONMENT:
        • Indoor office setting
        • Prolonged sitting at a desk and using a computer. Frequent, repetitive keyboard use TRAVEL: Some travel may be required - may require overnight stay. Must have a valid driver's license and be able to drive a car. SUPERVISORY RESPONSIBILITY: This position does not have direct reports OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Keywords: GlobalHealth, Inc., Oklahoma City , Compliance Auditor, Accounting, Auditing , Oklahoma City, Oklahoma

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