Texas Children's Hospital · 2 weeks ago
Manager, Compliance Monitoring & Auditing
Bellaire, TX
Full-time
Onsite
Mid, Senior Level
5+ years expTexas Children's Hospital is seeking a Manager of Compliance Monitoring & Auditing to oversee and conduct internal and external auditing activities related to regulatory and contractual requirements. This role involves developing audit tools, managing compliance activities, and ensuring ongoing compliance with federal and state regulations.
EducationHealth Care
Responsibilities
Ensure ongoing compliance with federal and state regulations and provide guidance and tools to assist the Health Plan in developing an auditing and monitoring program. Develop comprehensive audit tools to objectively measure internal performance and performance of third parties (i.e. subcontractors) against Health Plan metrics, policies, regulations, and industry standards. Internal and external audit tools with measurable metrics will be created with feedback from Senior Management must be reviewed and/or revised at least once annually
See to the Compliance Department’s accurate and complete auditing documentation, monitoring initiatives, compliance-based education, and correction of action plans. Analyze audit results and summarize areas of improvement needed. Review and update targeted training and educational materials that address deficiencies indicated by the auditing and monitoring program. Assist the Compliance Department with the issuance and management of corrective action plans related to auditing and monitoring indicators. Track and trend audit and monitor results. Maintain all auditing and monitoring records in accordance with record retention policy
Manage and develop the monitoring and auditing team within the Compliance Department
Monitor compliance activities using appropriate monitoring tools and techniques (Hotline, department interviews, committees, direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues, as appropriate. Report monitoring activities to senior leadership and governance committees as appropriate
Maintain ongoing monitoring activities using appropriate monitoring tools and techniques (Hotline, department interviews, committees, direct contact) to demonstrate program oversight and compliance with applicable regulators and internal policies and procedures. Follow up to resolve issues, as appropriate. Include monitoring activities in the quarterly audit report
Develop and maintain an effective awareness and education program to ensure workforce knowledge of corporate compliance (including billing compliance, CMS regulations, HIPAA and HITECH regulations, Texas Medicaid rules) by preparing and administering articles, course content for required education initiatives and providing guidance to workforce. Assist with the development, implementation and training of policies and procedures for billing compliance programs (HIPAA, HITECH, CMS, The Joint Commission, acceptance of gifts, conflicts of interest, billing and documentation)
Qualification
Required
Bachelors degree required
5 years progressive compliance, auditing, healthcare, and/or legal experience required
Preferred
CIA-Certified Internal Auditor The Institute of Internal Auditors
CPMA-Certified Professional Medical Auditor American Academy of Professional Coders
CHCRA-Certified Healthcare Risk Auditor Association of Health Care Auditors and Educators
CHA-Auditing for Compliance American Institute of Healthcare Compliance
Company
Texas Children's Hospital
Texas Children’s Hospital is a world-class pediatric facility, nationally recognized as a top children’s hospital.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Aisha J.
Vice President of Corporate Governance and Chief of Staff to the President & CEO
Mark Wallace
President and CEO
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