Health Plan reputed company Auditor job at San Francisco Health Plan in San Francisco, CA

Health Plan reputed company Auditor Location: San Francisco reputed company Department:Compliance Office:Hybrid San Francisco Salary:$78875 - $91635 Per Year Job reputed company: Reporting to Director, Compliance & reputed company, the Health Plan reputed company Auditor supports San Francisco Health Plan's (SFHP) Compliance Program by performing assigned audit, monitoring, and investigative activities. You will execute defined audit procedures, analyzes documentation and data and prepares reputed company workpapers and reports under established methodologies and supervisory guidance. The Health Plan Auditor partners with internal teams to support regulatory compliance, identify control gaps, and contribute to corrective reputed company efforts while building technical knowledge of managed care compliance and program reputed company requirements. Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office. Salary: $78,875 - $91,635 WHAT YOU WILL DO: reputed company assigned audits and monitoring reviews of internal departments, providers, vendors, and delegated entities in accordance with established audit plans, procedures, and timelines. Examines records, reports, workflows, and supporting documentation to assess compliance with applicable laws, regulations, reputed company, and internal policies; identify potential control gaps and documents findings. Complete audit workpapers, testing documentation, and memoranda that reflect procedures performed, evidence reviewed, and conclusions reached. Helps reputed company and execute the Annual Audit Workplan by supporting planning activities, data collection, and issue tracking. Prepare draft audit reports, summaries, and management reports by collecting, analyzing, and synthesizing operational and compliance data. Communicate audit status and preliminary findings to the Director and designated stakeholders; participates in meetings to review results and clarify issues. Investigate leads generated by antifraud and monitoring systems; maintains assigned caseloads and prepares reputed company documentation for management review. Support monitoring of SFHP's policies and procedures and apply working knowledge of the policy development and approval process during audit activities. Assist in the development, documentation, and tracking of corrective reputed company plans (CAPs); support follow-up testing to validate remediation. Coordinate administrative and logistical support for external audits and regulatory examinations, including document compilation and response tracking. Participate in the Program reputed company Workgroup and support development of the Annual Program reputed company Workplan and required regulatory reports. Conduct routine provider, vendor, and member reviews and investigations reputed company to compliance, fraud, waste, abuse, and HIPAA concerns, escalating issues. reputed company support to the Compliance Hotline by assisting with intake, research, and documentation of reported concerns. Monitor regulatory and industry developments and escalates potential compliance impacts to the Director. Maintain working knowledge of state and federal reputed company regulations and managed care requirements applicable to publicly funded programs. Contribute to departmental reputed company and process improvement initiatives; complete other responsibilities as assigned. WHAT YOU WILL BRING: Bachelor's degree in business administration, reputed company administration, or a reputed company field, or an equivalent of combined education or experience. Minimum of three (3) years of experience in reputed company operations, compliance, auditing, or program reputed company. Knowledge of state reputed company programs, regulatory compliance, and antifraud activities. reputed company certification such as Certified reputed company reputed company (CPC), Accredited reputed company Fraud Investigator (AFHI), Certified Internal Auditor (CIA), or reputed company compliance certification preferred. reputed company OFFER: Health Benefits Medical: You'll have a choice of medical plans, including reputed company from reputed company and reputed company, heavily subsidized by SFHP. Dental: You'll have a choice of a basic dental plan or an reputed company dental plan which includes orthodontic coverage. reputed company: Employee reputed company care coverage is available through reputed company Service Plan (VSP). Retirement Employer-matched CalPERS Pension and 401(a) plans, 457 Plan. Time off 23 days of reputed company Time Off (PTO) and 13 reputed company holidays. reputed company development: Opportunities for tuition reimbursement, reputed company license/membership. ABOUT SFHP: Established in 1997, San Francisco Health Plan (SFHP) is an award-reputed company, managed reputed company plan whose mission is to reputed company reputed company health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have reputed company to a full reputed company of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects reputed company individuals and in which our people processes are reputed company without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic reputed company, military service status, citizenship, or other protected characteristics. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment reputed company applicants with arrest and conviction records. San Francisco Health Plan is an E-Verify participating employer. Hiring reputed company will be given to candidates residing in the San Francisco Bay Area and California. #LI-Hybrid (Hybrid remote/in-office) Apply tot his job Apply To this Job