Compliance Manager-External Audits

Now hiring a Compliance Manager-External Audits!

The Compliance Manager for External Audit is responsible for managing and being the internal, and external, focal point for external audits from clients and regulators or their delegated audit firm. This person is responsible for responding timely and effectively to the external clients and audit agencies (Medicare, Medicaid, HHS, OPM, and their delegates) as required in the performance of audit response for the Presbyterian Health Plan. As well as oversee one direct report, External Audit Compliance Specialist.
The External Audit Compliance Manager will organize the audit functions and the individual audits. This will include: alerting the organization of announced audits; organize and assigning-out the audit deliverables, including identifying responsible owners; setting up audit kick-off meetings, internal and external; setting up the data gathering sites for associated audit inputs and communicating this to responsible owners; top level review of audit submission materials; gathering and delivery of audit materials to the auditors; utilizing the GRC platform to track audit status and submissions; reporting on audit progress and audit status. The External Audit Compliance Manager will be the responsible person for each audit for the organization, however the individual departments and designated responsible owners for those departments and functions will ultimately be responsible for all information supplied to the external audit agencies.

The External Audit Compliance Manager must work effectively with each of the applicable line-of-business Compliance Managers and the PHP leadership in the audit processes. Escalate issues early in the audit process. Lead the External Audit Compliance Specialist to work with the applicable line-of-business Compliance Managers who will work in tandem and assist the External Audit Compliance Manager/Specialist, if need be, in the audit process and will be aware of the audit, and applicable responses. Once a final report is issued the External Audit Compliance Manager will transition to the External Audit Compliance Specialist to work with the line-of-business Compliance Managers on any audit findings and observations for management of the applicable remediations through closure.

In the course of the audit process the External Audit Compliance Manager will insure Compliance Leadership as well as departmental leadership are aware of early audit issues and findings and will help in the identification of key risks to the organization and the evaluation of the internal control environment.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Ideal Candidate:

Bachelors degree health care management, accounting, finance or related field.

Five to seven years experience in compliance, or healthcare management, or auditing or law/regulations.

Managed care health plan experience in Medicare or Medicaid or Commercial required.

• Bachelors degree health care management, accounting, finance or related field.
• Five to seven years experience in compliance, or healthcare management, or auditing or law/regulations.
• Managed care health plan experience in Medicare or Medicaid or Commercial required.
• CHC or willing be obtained within 1 year
  Advanced skills in the following or ability to quickly develop:
• MS Office and products (Calendar; Word; Excel; PowerPoint)
• SharePoint
• Adobe Pro
• PEL
• DART
• Archer
  Desired skills but not critical:
• Claims processing applications
• Care Coordination systems
• Market Prominence, or other enrollment systems
  
  

Education Essential: Bachelor Degree

• Prepares work papers and provide evidence to support conclusions for higher risk areas according to established department guidelines and industry standards
• Directs fieldwork for audit efficiency and informs leadership of audit status to manage staff performance
• Assists leadership in writing internal audit reports regarding the external audit and discussing with compliance staff and management as well as internal departmental compliance liaisons
• Leads in coordinating follow-up audits and reviews based on results of prior audit recommendations. Assist the line-of-business Compliance Managers in evaluating the adequacy of management actions taken to mitigate audit findings and risks identified in the audit reports.
• Report results of follow-up audits to leadership.
• Participates in special project assignments
• Responsible for direct communication and coordination with departmental compliance liaisons and audit responsible owners.
• Leads and manages the External Audit Compliance Specialist and assigns activities

Expert skill level in:

• Technical writing
• Ability to organize materials and direct others in audit process
• Ability to put together and make presentations to various audiences
• Ability to verbally communicate audit outcomes and conclusions
• Communication internally and with external customers
• Ability to learn new information and skills quickly
• Use external secure ftp sites
• Excellent Time Management skills
• Critical Thinking, analytical skills and Problem Solving
• Identifying and resolving problems to achieve quality outcomes
• Negotiation skills
• Demonstrates professionalism
• Ability to handle multiple projects and deadlines simultaneously
• Demonstrates proficient knowledge, skills & experience in applying the principles & practices of internal auditing in accounting, financial and or operational environments
• Experience in planning, executing, and reporting on audits
• Model CARES Behavior and is committed to organizational Promise and Strategy
• Other duties as assigned.
  
  

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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