Location: Pearland Administrative Office
Department: Kelseycare Managed Care- Quality
Job Type: Full Time
Kelsey-Seybold Clinic. Your Doctors for Life.
Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
Reporting to the Manager of Compliance and Regulatory Affairs the Compliance Auditor will have primary responsibility for coordinating and conducting regular internal audits to ensure the plan meets the regulatory and compliance requirements of federal and state laws and regulations. This position supports the company’s compliance investigations program and activities to ensure effective, appropriate and timely investigations of reports of potential non-compliance across the company, and for ensuring appropriate documentation, trending, and reporting on investigative activities and results.
The Compliance Auditor will identify, track, trend, and investigate compliance issues and concerns reported to Compliance department’s attention, and perform preliminary analysis of fraud and abuse reports. The Compliance Auditor is responsible for ensuring the strictest form of confidentiality is applied to all audits and investigations conducted.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
A. Bachelor degree or equivalent work experience
A .3-5 years’ experience with Managed Care organization or health plan 3 years of management or supervisory experience. Strong knowledge of Medicare Advantage
A. Knowledge of Managed Care payment methodologies, proficient in MS Office products, and process improvement. Experience performing multiple projects and working with team members.
A. Excellent written and verbal communication skills. Must be detailed oriented and have strong organization and time management skills.