Gonzaba Medical Group

  • San Antonio, TX, United States
Gonzaba Medical Group San Antonio, TX, USA
The Compliance Auditor will assist in the overall quality, compliance, and auditing activities to ensure compliance of Health Plan Delegation contracts, organizational policies, industry standards, and applicable federal and state laws. Work with delegated teams (Utilization Management (UM), Claims, Network Development, Credentialing, Administrative Audits) to ensure readiness, well documented evidence, and reporting and policies are put in place. Assists with the submission of the Delegation documents. Tracks responses, scoring and oversees any Corrective Action Plan development & submissions. Duties: Conducts pre-delegation audits, annual audits, interim delegation reporting, training, etc. Reviews policies at least annually ensuring policies meet CMS standards. Updates departmental policy to meet delegation requirements Works alongside the Management staff of delegated teams to ensure policy is properly trained and operationalized. Responsible for monitoring and reporting...