Compliance Auditor -Remote

Compliance Auditor

About MedZed:

MedZed delivers care into the homes of people with complex medical, behavioral health and social needs, typically in underserved communities. Our multi-channel engagement platform locates those that traditional bricks and mortar systems are unable to adequately reach despite their disproportionate and avoidable use of healthcare resources.

Our team of Community Health Navigators and Licensed Vocational Nurses in-the-home are linked to MedZed primary care clinicians and other professionals using a telehealth platform. Practicing in panels, our team delivers extraordinary care and successfully manages patient outcomes. MedZed's care model is scalable and customizable to individual client and patient needs and has demonstrated excellent outcomes and high patient satisfaction. Serving members in seven states, MedZed has completed over 250,000 in-home visits and continues to expand throughout the country. Join the team and become part of our story.

Job Description:

The successful candidate will support the development and implementation of MedZed's Quality Improvement and Quality Management program. The role is responsible for full compliance and high performance in our Medicaid and Medicare managed care contracts. This includes creating, refining, and tracking quality improvement initiatives for our care teams, ensuring high performance on contracted Service Level Agreements' and maintaining excellent compliance with health plan contracts and state and federal regulations.

Reporting to the Vice President Quality and Compliance, the successful candidate will function as a key member of the operational management team, provide leadership and oversight to the strategic development and implementation of the quality and compliance programs. This includes responsibility for directing and supervising data collection, analysis, evaluation, and reporting for both internal purposes and external entities. When needed, they will develop recommendations for quality remediation plans as well as continuous monitoring. In addition to leading quality improvement initiatives, the successful candidate will attend monthly Peer Review and quarterly Joint Operations Committee meetings.

Essential Duties and Responsibilities

• Conduct thorough audits of health plan operations to assess compliance with regulatory requirements.
• Review and analyze health plan policies, procedures, and documentation to identify areas of non-compliance.
• Work with department analysts to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
• Research and determine accuracy of documentation in MedZed databases and systems.
• Develop and implement corrective action plans to address identified compliance issues.
• Collaborate with cross-functional teams to provide guidance and support in developing and maintaining effective compliance programs.
• Stay updated on relevant laws, regulations, and industry best practices to ensure ongoing compliance.
• Prepare comprehensive audit reports and present findings to management, providing insights and recommendations for enhancing compliance efforts.

Required Skills and Qualifications

• Bachelor's degrees in healthcare administration, business, or related field
• Previous experience in healthcare compliance or auditing
• Requires attention to detail and strong knowledge of healthcare regulations, such as HIPAA, Medicaid, and Medicare
• Excellent analytical and problem-solving skills
• Effective communication and interpersonal skills to collaborate with various stakeholders.
• Must have strong organizational skills and excellent oral and written communication skills.
• Highly organized, self-starter and self-disciplined to work independently and manage own schedule efficiently.
• Must be able to prioritize and follow guidelines/meet deadlines.
• Must be able to thrive in a fast-paced environment that is constantly evolving with new requirements.
• Ability to use smart phones and laptops including phone applications and software programs such as Microsoft office and excel.
• Ability to troubleshoot if technology is not working and utilizing company IT services if appropriate.
• Knowledge and experience with electronic health record systems including understanding how to navigate and document professionally.
• Always maintain confidentiality and follow HIPAA standards in safeguarding patient information.
• Represent the company with professionalism.