Compliance Auditor

Why should you consider a career with Colorado Access?
 

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.
 

1. Find work/life balance:  We offer PTO, floating holidays, seven company paid holidays, work from home options (exceptions apply), an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:
 

We are looking for a Compliance Auditor like you who can help shape our vision and support our mission. Here is what the day-to-day functions will look like:

• Assists the Manager of Compliance Risk & Auditing in the development of an annual audit plan and provider training plans and activities.
• Assists with the maintenance of the compliance audit program, including schedules, standards, processes, reports, and tools in close collaboration with the Manager of Compliance Risk & Auditing.
• Assists Manager of Compliance Risk & Auditing with project management of external vendors and contractors optimizing utilization according to budget.
• Assists in conducting interrater reliability testing across internal audit team and external vendors.
• Assists in conducting regular internal reviews and audits to ensure compliance procedures are followed across the Company, routine and ad hoc claims audits and reviews of medical records to assess whether services delivered to the member and billed to Colorado Access are accurate, appropriate, and meet state, federal, and contractual requirements. Assists in the management of each audit from start to completion including:
  • Planning and verification of the audit sample universe.
  • Conducting review of supporting documentation.
  •  Preparing aggregate summary reports.
  • Providing audit training and support to key personnel and providers.
  • Completes audit documentation and reporting in a timely manner and in accordance with established auditing methodologies and professional standards.
  • Coordinates implementation of internal and external corrective action plans, monitoring progress and completion, coordinating interviews and document gathering; escalates as required. Conduct re-audits to verify corrective actions were fully implemented and effective.
• Assists in the management the overpayment tracking and reporting process and deliverables.
• Tracks and trends compliance audit statistics and recommend strategies to improve provider compliance.
• Assists in the management of the HCPF-required performance improvement projects related to provider audits.
• Identifies and monitors risk by conducting ongoing risk assessments and develops audit plan to address high-risk areas. Provides technical assistance as needed.
• Provides technical assistance as needed.
• Maintains comprehensive audit and monitoring tools policies and procedures related to the compliance audit program, including schedules, standards, processes, reports, record keeping and audit tools.
• Develops and prepares reports on compliance audit program activities for submission to internal stakeholders as well as state and federal oversight agencies.
• Assists in the development of project plans. Contributes to an environment that fosters innovation and enables continuous improvement of the risk and compliance mindset across the Company.
• As requested by Manager ,assists in investigations related to allegations of fraud, waste and abuse and, as appropriate, assist in the process of recovery of overpayments.
• Reads, understands, and maintains current knowledge of complex federal and state laws, regulations, rules and bulletins applicable to the company’s corporate compliance program.
• Assists with special project preparation and follow-up, as needed, under the direction of the Director of Compliance.
• At the direction of the Director of Compliance ,attends and presents to various committees or meetings.

What you will bring:

Education: Bachelor’s degree in business, health administration, public health or a related field.  Equivalent combination of experience and coding or auditing certifications may substitute with a preference for five years progressive relevant work experience.

Experience: Three years’ experience in a compliance, medical coding or auditing role required.  Managed care and/or Medicaid/Medicare experience desired.  Preference for CHP or auditing experience
 

Knowledge, Skills, and Abilities:  Must be detailed oriented with excellent problem-solving skills.  Demonstrates support for the company’s mission, vision and values.  Position requires excellent written and verbal communication skills.  Ability to assimilate and process complex verbal and written communications. Strong organizational and time management skills required to multitask effectively and adapt to changing priorities and responsibilities.  Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, and Outlook) and computer database programs.  Must be able to manage multiple priorities and projects with tight deadlines. Utilizes high degree of self-direction by analyzing an issue, developing a plan to resolve, and implementing the resolution. Strong knowledge of managed care health plan functions and interactions as they related to compliance. Basic knowledge of compliance systems, processes and reporting. Strong leadership skills, with the ability to influence without authority, establish direction, build alliances, and motivate others.

Licenses/Certifications: Certified Professional Coding (CPC), or other coding or auditing certification preferred and can be substituted for years of experience.  A valid driver's license and proof of current auto insurance will be required for any position requiring driving. 

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.


 

Pay, Perks and Benefits at Colorado Access:
 

The compensation for this position is $60,000.00 to $80,000.00 annually. The pay rate/salary is commensurate with experience. 
 

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date. 
• Supplemental insurance such as critical illness and accidental injury. 
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent). 
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility). 
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:
 

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’
 

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.