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North East Medical Services · 1 month ago

MANAGED CARE COMPLIANCE AND AUDIT COORDINATOR

Burlingame, CA

Full-time

Onsite

New Grad, Entry Level

$42/hr - $48/hr

North East Medical Services is seeking a Managed Care Compliance and Audit Coordinator to assist with compliance and auditing functions. The role involves conducting internal audits, collaborating with various teams to ensure compliance, and monitoring regulatory requirements.

Hospital & Health Care

Responsibilities

Conduct internal audits to systematically assess the department’s risks and efficacy of delegated functions and activities, policies, and procedures, using assessment and auditing tools approved by contracted health plan and/or developed internally

Coordinate inter-department and cross-department level projects including planning, workgroup meetings, collecting and setting agenda items, creating meeting minutes, and following up with action items

Assist with administrative tasks from the MSO Compliance and Audits (C&A) Manager. The C&A Team and other MSO units work collaboratively to promote quality assurance and quality improvement activities

Collaborate with different MSO units and external provider offices to aid plans in the investigation of member grievances and potential quality issues (PQI). Assist with the issuance of CAPs for identified non-compliance and monitors for remediation

Collaborate with different MSO units, including Claims, UM, Provider Relations, Care Management, and Data Reporting, to relay compliance requirements, audit scores, corrective action plans, and to ensure non-compliance area(s) is corrected and monitored

Work closely with MSO C&A manager, department managers, and external health plan auditors with compliance audit activities, including but not limited to internal and external of communication about audit calendar/schedule and level of requirement, report submission, gathering of documents, etc., to facilitate a smooth and positive audit experience from external auditors

Analyze regulatory guidance documents, document requirements, understand & communicate requirements, and collaborate with different teams to monitor compliance

Analyze reports and present findings to the C&A team and different MSO units

Collaborate with different teams and departments to ensure compliance with NCQA standards to maintain NEMS’s NCQA accreditations

Performs other job duties as required by manager/supervisor

Qualification

Compliance auditingHealthcare experienceData analysisNCQA standardsMicrosoft OfficeCustomer serviceMulti-taskingFluent in EnglishFluent in ChineseWritten communicationVerbal communicationProblem-solvingInterpersonal skillsConfidentialityTeam collaboration

Required

Bachelor's degree in relevant field is required. Combination of education and relevant work experience may be considered in lieu of a Bachelor's degree

Strong knowledge of Microsoft Office (PowerPoint, Word, Excel, Outlook)

Excellent written and verbal communication skills

Ability to multi-task and work with highly sensitive and confidential matters

Excellent problem-solving skills and be able to think critically

Excellent interpersonal and customer service skills

Ability to work with all levels of staff

Must be able to fluently speak, read, and write English

Preferred

Experience in a healthcare setting or managed care is strongly preferred

Experience in compliance and/or operational auditing is preferred

Previous experience in quality assurance and quality improvement related activities in healthcare related setting is preferred

Experience with analyzing and presenting data is preferred

Knowledge of NCQA standards and guidelines is preferred

Fluent in Chinese (Cantonese and/or Mandarin) preferred

Fluency in other languages are an asset

Benefits

Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children

Company contribution to 401(k)

Company

North East Medical Services

North East Medical Services (NEMS) is one of the largest community health centers in the United States targeting the medically underserved Asian population.

Founded in 1968