Senior Compliance Auditor
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
The Senior Compliance Auditor works under the direction of the Director of Compliance & Privacy to provide information, analysis, and recommendations for compliance activities supporting Community's adherence to all regulatory and legal requirements. The role also serves to research information and to work with operations on reasonable and logical solutions in order to accomplish compliance. The Senior Compliance Auditor is responsible for conducting internal monitoring as part of the Compliance program and as outlined in the annual audit and monitoring work plan.
- BA/BS Iin Healthcare Administration or Business Administration. Four years of experience in conducting client facing activities may substitute for the degree requirement.
- CHC, CCEP or CHPC certification preferred.
- Four years in the healthcare payor industry (Medicare/Medicaid), at a team lead/supervisor level, conducting client facing activities.
- Strong analytical and reporting skills. Ability to organize tasks and work independently.
- Ability to build a strong network within Community
- Practical teaming skills demonstrated through working with and maintaining excellent relationships with internal and external customers
- Solid knowledge of Medicaid, Medicare laws and requirements; federal, state, civil and criminal statutes
- MS Word /MS Excel/ MS PowerPoint
- Experience working in Data Analysis, Risk Management or Regulatory Compliance function
Benefits and EEOC
Community employees’ benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and choices in meeting your specific needs.
Community is an Equal Opportunity Employer.