We are looking for a Senior Compliance Specialist, someone who’s ready to grow with our company. In this position you will independently and cooperatively plan and manage audits, reviews, investigations and projects to ensure compliance with Texas Children's policies/procedures and state and federal rules, regulations, and statutes. To identify risks by conducting ongoing risk assessments for Texas Children's and document and report the risk(s) to Senior Management.
Skills & Requirements
- Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees unless approved for a medical or religious exemption.
- Required H.S. Diploma or GED with preferred bachelor's degree
- Preferred Licenses/Certifications
- CPC - Cert-Cert Professional Coder
- CCS-P - Cert-CCS-P Physician Based
- RHIA - Cert-Reg Health Inform. Admins
- CCS - Cert-Cert Coding Specialist
- CHC - Certified in Healthcare Compliance
- Required 9 years in a regulatory environment including specific experience in project management and audit type work such as planning, supervising, executing, and reviewing audits, reviews, or investigations
- A bachelor's degree may substitute for four years of experience. A master's degree may substitute for two years of experience.
Job Duties & Responsibilities
- Conducts and Manages Compliance Audits, Reviews, Projects, or Investigations. Ensures that written reports and correspondence are organized, accurate, appropriate in content, professional in appearance and appropriately convey the reported issue(s). Assists operational areas with implementing recommended changes to enhance operations or mitigate risk.
- Documents compliance issue(s) and prepares scope memorandum/project charter in accordance with agreed deadline. Confers with necessary parties in an effective and appropriate manner, including in-house legal counsel or external counsel when necessary and communicates any issues or concerns to the Manager in an appropriate and timely manner.
- Prepares Audit or Review Work Program and obtains supervisory approval in accordance with agreed deadline.
- Conducts fieldwork and/or information gathering in an effective, efficient, professional manner.
- Ensures that audit/review/project/investigation issues/findings are verified with sources for accuracy and appropriately supported by comprehensive, accurate, well-organized work papers.
- Prepares comprehensive, accurate documentation to support recommendations and/or proposed resolutions. Ensures that the audit/review/project/investigation is completed by the agreed upon deadline (or documents the exception), that workpapers are complete, and that staff and/or team-assigned work has been reviewed.
- Identifies significant issues within the scope of the audit/review/project/investigation ensuring compliance with appropriate statutes, rules, and regulations. Obtains supervisory approval to seek external legal counsel when necessary.
- Prepares formal report to senior management documenting issues/findings identified during the audit/review/project/investigation. Documents agreed upon resolution.
- Develops or assists in developing implementation plans.
- Leads, assists or monitors team assigned to implement recommended operational changes designed to mitigate risk and/or improve operational processes.
- Writes audit report and/or audit memoranda and/or project report in a timely manner as observed by the Assistant Director.
- Documents interviews, meetings, issues thoroughly and accurately in support of audit issues/findings.
- Schedules, prepares for and attends exit conference to discuss audit/project findings, area(s) of risk, identified issues and proposed recommendations for change.
- Exhibits the ability to communicate the issues to all levels of management, including senior management.
- Obtains written response to the audit/project report within agreed upon timeframe. Ensures appropriate follow-up of findings/issues.
- Conducts Compliance Training. Assists in the On-going Development/Maintenance of the Organizations’ Compliance Program per OIG Requirements.
- Monitors Regulatory Environment; evaluates statutes, regulations, laws to determine applicability to Texas Children’s. Communicates information to appropriate Texas Children’s personnel.
- Engages in risk analysis activities.
- Leads the work of Compliance Specialists, Compliance Assistant(s) and Others.
- Seeks Professional Growth & Development.
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.