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AIS Compliance Auditor

Posted on 9/19/2014

Description: The Compliance Auditor assists in monitoring compliance with all regulatory requirements.  This position is responsible for conducting, coordinating, and reporting audit/investigative activities for the purpose of ensuring compliance with contract requirements and regulatory agencies including company policies and procedures.  The Compliance Auditor will assist with the reporting and investigative activities for the purpose of preventing and detecting fraud, waste, or abuse.

The Compliance Auditor is responsible for performing assigned internal audits and the coordination and completion of activities related to regulatory requirements and contract compliance within the AIS Compliance Department for a Knox-Keene licensed Health Maintenance Organization (HMO).

Requirements: Bachelor’s degree required or significant experience within the financial, claims, legal or regulatory support preferably in the health care industry.  Experience may be substituted on a year by year basis. Two (2) years of experience in auditing, accounting, compliance, legal or regulatory support and preferably in the health care related field required.  Managed care experience with auditing experience desired. Knowledge of Managed care systems of a Knox-Keene licensed health maintenance organization. Basic procedures utilized in claims processing in a managed care environment; medical reimbursement methodologies and training.  Understanding and interpretation of state and federal regulations. Knowledge of HIPAA policy and procedures. Valid Driver License and proof of State required auto liability insurance.

We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E

Req# 166-14