Manager of Compliance Risk & Auditing

11100 E Bethany Dr, Aurora, CO 80014, USA Req #708
Tuesday, September 24, 2024

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford.  Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

 

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

 

  1. Find work/life balance:  We offer PTO, floating holidays, seven company paid holidays, work from home options (exceptions apply), an Employee Assistance Program and a 401K.
  2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
  3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

 

 

What you will do:

 

We are looking for a Manager of Compliance Risk & Auditing who can help shape our vision and support our mission. Here is what the position will look like.

  • Leads the development of the audit plan in collaboration with the Director of Compliance Programs aligning audit priorities with organizational risk management strategies and regulatory requirements.
  • Oversees the compliance audit program, driving supporting the strategic direction for audit schedules, methodologies, and reporting standards.
  • Provides insights, advising leadership on audit outcomes, trends, and compliance strategies.
  • Manages and mentors audit staff, fostering a culture of continuous improvement and technical excellence.
  • Supervises and optimizes the engagement of external vendors and contractors, ensuring effective utilization and alignment with budgetary goals.
  • Leads complex interrater reliability testing across internal teams and external vendors to ensure consistency and precision in the audit process.
  • Manages and oversees internal and external audits ensuring adherence to state, federal and contractual requirements through comprehensive reviews of claims and medical record evaluations.
  • Directs the end-to-end management of audit projects, from planning to completion, including oversight of sample selection, documentation review, and corrective action follow-up.
  • Provides leadership in investigating fraud, waste, and abuse allegations, including guiding recovery processes for overpayments.
  • Manages the tracks and trending of compliance audit statistics and recommends strategies to improve provider compliance with state, federal and contractual requirements.
  • Develops strategic initiatives for performance improvement projects related to provider audits, ensuring compliance with HCPF requirements.
  • Conducts advanced risk assessments, identifying high-risk areas and designing audit plans to mitigate organizational risk.
  • Oversees the development and maintenance of compliance audit policies and procedures, ensuring alignment with evolving regulatory frameworks.
  • Represents the audit function in executive meetings and provides key updates to senior leadership and external regulatory bodies.
  • Oversees the development and presentation of audit reports for internal stakeholders and external regulatory agencies.
  • Develops project plans and assists in setting strategic direction of audit program and other initiatives.
  • Contributes to shaping the strategic direction of the audit and compliance program, promoting innovation and a proactive compliance culture across the organization.
  • Provides support, education, and training to staff to build risk and compliance awareness.
  • Maintains in-depth, up-to-date knowledge of complex federal and state laws, regulations, and bulletins, providing strategic guidance to senior leadership to ensure the company’s corporate compliance program aligns with regulatory expectations.
  • Leads special project initiatives, providing high-level support and follow-up, and ensures successful project execution under the strategic direction of the Director of Compliance Programs.

 

 

What you will bring:

 

Education: Bachelor’s degree in business, health administration, public health or a related field. Equivalent combination of experience and/or education may substitute with a preference for five years progressive relevant work experience. Preference for advanced degrees (MBA, MPH) with 5+ years of progressively responsible experience in compliance.

 

Experience: Four years’ experience in a compliance role required. Managed care and/or Medicaid/Medicare experience desired. Experience leading compliance initiatives at a strategic level preferred.

 

Knowledge, Skills, and Abilities: Must be detailed oriented with excellent problem-solving skills. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal communication skills. Ability to assimilate and process complex verbal and written communications. Strong organizational and time management skills required to multitask effectively and

adapt to changing priorities and responsibilities. Must be proficient in Microsoft office applications (Word, Excel, PowerPoint, and Outlook) and computer database programs. Must be able to manage multiple priorities and projects with tight deadlines. Utilizes high degree of self-direction by analyzing an issue, developing a plan to resolve, and implementing the resolution. Strong knowledge of managed care health plan functions and interactions as they related to compliance. Basic knowledge of compliance systems, processes and reporting. Strong leadership skills, with the ability to influence without authority, establish direction, build alliances, and motivate others.

Licenses/Certifications: Certified professional coder (CPC) or Certification in Healthcare Compliance (CHC) required. A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

 

 

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

 

 

Pay, Perks and Benefits at Colorado Access:

 

The compensation for this position is $99,200.00 - $120,750.00 annually. The pay rate/salary is commensurate with experience. 

 

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

  • Medical, dental, vision insurance that starts the first day of the month following start date. 
  • Supplemental insurance such as critical illness and accidental injury. 
  • Health care and dependent care flexible spending account options.
  • Employer-paid basic life insurance and AD&D (employee, spouse and dependent). 
  • Short-term and long-term disability coverage.
  • Voluntary life insurance (employee, spouse, dependent).
  • Paid time off
  • Retirement plan
  • Tuition reimbursement (based on eligibility). 
  • Annual bonus program (based on eligibility, requirements and performance).

 

Where you will work:

 

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’ 

 

 

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.

Other details

  • Job Function Manager
  • Pay Type Salary
  • Min Hiring Rate $99,200.00
  • Max Hiring Rate $120,750.00
Location on Google Maps
  • 11100 E Bethany Dr, Aurora, CO 80014, USA