The Compliance Auditor plays a critical role in advancing the mission of Community Health Plan of Imperial Valley (CHPIV) by ensuring that administrative/non-clinical functions performed by delegated entities are in full compliance with regulatory, contractual, and clinical standards.
About the roleOur new Compliance Auditor will do the following:
- Evaluate process compliance and operational workflows for internal and delegated functions.
- Identify systemic issues and contribute to corrective action planning.
- Monitor regulatory metrics and reporting to committees.
- Conduct audits of non-clinical delegated functions including claims, encounters, credentialing, language assistance services, and program effectiveness.
- Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and materials.
- Assess compliance with DHCS, DMHC, CMS, and NCQA regulatory requirements, as well as contractual obligations.
- Identify gaps in documentation, workflows, and performance that could result in audit findings or compliance risks.
- Monitor corrective action plans and validate the resolution of findings to ensure sustained compliance.
- Support enterprise-wide verification studies and external audit readiness, including pre-audit documentation review and file validation.
- Collaborate with internal departments and external delegates to ensure alignment and operational consistency.
About our next team memberOur new Compliance Auditor will have the following:
- Bachelor's degree in Healthcare Administration, Public Health, Business, or a related field; equivalent experience may be considered in lieu of degree
- Minimum of 3-4 years of experience in compliance, auditing, or regulatory oversight within a managed care or healthcare delivery environment.
- Familiarity with Medi-Cal and/or Medicare regulatory requirements (DHCS, DMHC, CMS).
- Strong understanding of delegated functions such as claims, encounters, credentialing, and language assistance services.
- Demonstrated ability to review and interpret policies, procedures, and operational workflows.
- Excellent organizational, analytical, and time management skills with the ability to manage multiple priorities.
- Strong written and verbal communication skills, including the ability to draft audit findings and compliance reports.
- Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and experience working with audit tracking systems or similar tools.
- Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
Our commitment to you- A competitive salary of $80,000-$100,000/ year
- Health, dental, and vision insurance that is paid 85% for you and your family
- Paid life and disability insurance
- A retirement plan with a generous match
- Paid time off
- A chance to make a real difference in the Imperial Valley community
