Job Description

Job Description

Job Description

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

• Integrity

• Accountability

• Collaboration

• Trust

• Respect

Disclaimers:

• Flexible work schedule is based on job duties, department, organization, or business need.

• Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

Under the general direction of the Internal Audit Manager, the Internal Auditor performs, plans, and conducts audits of assigned areas and documents in findings workpapers in accordance with department standards. The position will also lead the internal audit process, develop reports regarding audits, and analyze, track and trend audit findings. Incumbent shall perform and coordinate follow-up audits to determine if management has taken action to mitigate risks identified. Assist with regulatory audit(s) preparation and coordination. Participates in special reviews as necessary.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

• Prepare audit programs and conducts audit reviews of assigned areas

• Provide independent evaluations of operational and financial controls, policies, and procedures

• Prepare audit workpapers, observations, and reports to document audit work.

• Obtain and review evidence ensuring audit conclusions are well-documented.

• Identify internal control weaknesses and non-adherence with regulatory requirements.

• Perform and coordinate follow-up audits to determine if management has taken action to mitigate risks and findings identified.

• Conduct reviews and audits of selected departments, to evaluate the extent of compliance with policies and procedures and regulations.

• Perform and document risk assessments of organizational objectives during audits.

• Communicate results of reports, analysis, and root causes to Internal Audit Manager.

• Maintain accurate record-keeping of all audits and ensure all deadlines are met.

• Assist in the revision of audit tools in accordance with standards set by ICE, NCQA, the Plan's policies and procedures and other State and Federal guidance tools as required.

• Participate in the Joint Operations Committee (JOC) meetings.

• Participate in the Compliance Committee meeting.

• Perform other duties as assigned.

MINIMUM QUALIFICATIONS

Education & Experience:

• Required: Bachelor’s degree in Business Administration, Accounting, or Public Health

• Preferred: Master’s degree in Business Administration, Healthcare Administration, or Public Health

Equivalent In lieu of degree:

• 3-4 plus years of experience in audit or compliance, preferably in a managed care environment.

• Experience with developing audit methodologies for conducting audits.

KNOWLEDGE, SKILLS & ABILITIES

Preferred Qualifications:

• Working knowledge of Internal Audit, Managed Care, Risk Management, Controls Testing

• Ability to think critically, display professionalism, communicate effectively, and adapt to change

• Additional experience or related experience in managed care, Medi-Cal, Medicare, leadership experience, etc.

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Competency Statements

• Management Skills - Ability to organize and direct oneself and effectively supervise others.

• Business Acumen - Ability to grasp and understand business concepts and issues.

• Decision Making - Ability to make critical decisions while following company procedures.

• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Consensus Building - Ability to bring about group solidarity to achieve a goal.

• Relationship Building - Ability to effectively build relationships with customers and co-workers.

• Presentation Skills - Ability to effectively present information publicly.

• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Judgment - The ability to formulate a sound decision using the available information.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

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