Managed Care Compliance & Audit Specialist

North East Medical Services; Burlingame (CA); Presencial; USD 90 000 - 120 000; Tempo integral

Resumo da oferta

North East Medical Services seeks a Managed Care Compliance and Audit Coordinator in Burlingame, CA to support the Compliance and Audit Manager with audits, regulatory monitoring, and NCQA activities within the MSO.

You will coordinate cross‑department projects, prepare audit materials, and liaise with Claims, UM, Provider Relations, Care Management and Data Reporting to ensure timely findings and corrective actions.

Qualificações

• Bachelor’s degree required; combination of education and relevant work experience may be considered.
• Experience in a healthcare setting or managed care preferred.
• Experience in compliance and/or operational auditing preferred.
• Quality assurance/quality improvement experience in healthcare preferred.
• Experience with analyzing and presenting data preferred.
• Knowledge of NCQA standards preferred.
• Strong knowledge of Microsoft Office (PowerPoint, Word, Excel, Outlook).
• Excellent written and verbal communication skills.
• Ability to multi-task and handle highly sensitive/confidential matters.
• Strong problem-solving and interpersonal skills; ability to work with all staff levels.

Responsabilidades

• Conduct internal audits to assess risks and efficacy of delegated activities, using approved tools.
• Coordinate cross-department projects, planning, meetings, and minutes; ensure follow-up actions.
• Assist with MSO Compliance & Audits administrative tasks and quality initiatives.
• Collaborate with Claims, UM, Provider Relations, Care Management, and Data Reporting on compliance matters.
• Support audits with external health plan auditors; prepare documents and report findings.
• Analyze regulatory guidance and monitor compliance across teams.
• Present findings to the C&A team and MSO units.
• Help ensure NCQA accreditation standards are maintained.
• Perform other duties as required by management.

Conhecimentos

Communication

Problem-solving

Interpersonal skills

Multitasking

Confidentiality

Attention to detail

Data analysis

Formação académica

Bachelor's degree in relevant field

Ferramentas

Microsoft Office

Descrição da oferta de emprego

North East Medical Services seeks a Managed Care Compliance and Audit Coordinator in Burlingame, CA to support the Compliance and Audit Manager with audits, regulatory monitoring, and NCQA activities within the MSO.

You will coordinate cross‑department projects, prepare audit materials, and liaise with Claims, UM, Provider Relations, Care Management and Data Reporting to ensure timely findings and corrective actions.