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Compliance Auditor

HealthSun Health Plans • Miami, FL

Posted 22 days ago

Job Snapshot

Travel - None
Experience - At least 2 year(s)
Degree - 4 Year Degree
Healthcare - Health Services
Health Care
Relocation - No


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Job Description

HealthSun Health Plans is seeking energetic,talented and qualified professionals to join us in our mission of changing the healthcare experience of our members - making it easier, friendlier and more accessible.  If you are looking for a challenging and rewarding career with a chance to make a real difference in your community, please apply.

HealthSun Health Plans is headquartered in the Coconut Grove area of Miami, Florida supporting the needs of Medicare Advantage recipients throughout South Florida. We are proud to offer outstanding career advancement opportunities, competitive salaries, paid holidays, medical & dental insurance plans, Paid Time Off, disability benefits, and a 401(k) retirement savings plan.

The compliance auditor is responsible for the ensuring compliance with CMS regulations and internal controls by conducting audits and recommending improvements in internal control structure.

Essential Duties & Responsibilities:
  • Accomplishes compliance requirements by notifying departments of internal or external compliance audits.  
  • Follows production, productivity, quality, and department standards; identifies operational problems and identifies work process improvements. 
  • Assists with monitoring departmental issues identified either by the department or by compliance, as a result of audits and when required will develop a corrective action plans.
  • Prepares audits by using CMS protocols and guidelines. 
  • Maintains regulatory and statutory compliance, develops controls by examining and analyzing records, reports, policies, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.
  • Completes audit paper work and memorandums by analyzing the information and preparing the reports on findings for the Chief Compliance Officer.
  • Prepares corrective action plans based on deficiencies noted in audits, issue logs, Dashboards or Risk Assessments.
  • Keeps track of any complaints reported to CMS against the Plan and responses regarding these violations are the responsibilities of the Marketing Compliance Auditor. Conducting an analysis of existing compliance records and making any necessary updates would also fall under this category.
  • Assists in the investigation and response of Non-Compliance issues and or notices.
  • Provides, records, maintains and reviews all compliance training to Plan employees and Providers.
  • Enhances job knowledge by participating in CMS educational Webcasts, CMS training and educational events, reading regulatory publications, reading Medicare Manuals and guidance. 
  • Oversees the delegated entities which include the creation and implementation of the corrective action plans in order to ensure and maintain compliance with federal, state, and contractual requirements.
  • Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
  • Promotes and contributes to a positive, problem-solving environment.
  • Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.
  • Complies with company policies and procedures and maintains confidentiality of records in accordance with state and federal laws.
  • Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations. 
  • Participates in meetings, training and in-service education, as required. 
  • Performs other duties as assigned.

Job Requirements

  • Minimum of High School diploma or equivalent
  • Bachelor's degree from an accredited college or university in Health Services or related field preferred 
  • Minimum 2 years of experience in the Healthcare field
  • Applicable knowledge of healthcare laws, regulations, and standards
  • Applicable knowledge of CMS regulations
  • Analytical skills and objective judgment; ability to (1) function independently on audit assignments without direct supervision, and (2) draw logical conclusions indicated by objective evidence.
  • Working knowledge of the Privacy and Security Health Insurance Portability and Accountability Act (HIPAA) regulations
  • Excellent computer knowledge is required, including proficient knowledge of Microsoft Office
  • Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization
  • Ability to work effectively independently and in a team environment
  • Ability to read, analyze, and interpret technical procedures or governmental regulations
  • Ability to write reports, business correspondence, and procedure manuals
  • Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public
  • Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume
  • Must be self-motivated, organized and have excellent prioritization skills
  • Must be able to work well under stressful conditions
  • Must be able to work in a fast paced environment
  • Fluency in Spanish and English required
HealthSun Health Plans and its affiliated companies is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs.M/F/D/V.

HealthSun and its affiliates are also a drug-free workplace.

*Internal candidates must submit the Internal Application Form approved by his/her supervisor before interviewing with HR. Qualified candidates will be considered by the Hiring Manager.
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