Auditing Director jobs in California

THE POSITION

Company: Advanced Medical Management, Inc. (AMM)

Title: Director – Auditing, Testing, and Monitoring

Location: Long Beach, CA

Reporting Lines: The Chief Compliance and Ethics Officer (the CCEO)

ABOUT AMM

AMM’s mission is to offer flexible administrative healthcare services that improve patient health, obtain profitability, maintain independence, and achieve 5-Star Quality. Our core values of Integrity, Collaboration, and Quality have driven our evolution from a physician practice management company to an Independent Physician Association (IPA) management company and fiscal intermediary administering and servicing a variety of commercial and government agency clients.

THE ROLE

As a member of AMM’s Compliance and Ethics team, the Director – Auditing, Testing, and Monitoring is an important driver of our mission. They are responsible for leading the Company’s Compliance & Ethics Program (the Program) auditing, testing, and monitoring initiatives. Robust auditing, testing, and monitoring capabilities are essential to fulfilling the expectations of AMM’s key stakeholders, including patients and their families and government agencies, and AMM is committed to exceeding those expectations. The Program is led by AMM’s CCEO, who reports to AMM’s Chief Executive Officer and the AMM Board, and who oversees and manages the AMM Compliance Committee, consistent with industry best practices.

The Director – Auditing, Testing, and Monitoring is expected to exemplify the Company’s culture and core values. This is a leadership role that requires sound and risk-aware judgment, productive collaboration across the Company, and demonstrated success in leading a team of audit professionals.

ESSENTIAL DUTIES & RESPONSIBILITIES

The following description provides an overview of primary responsibilities for this director position; it should not be interpreted as all-encompassing.

General Responsibilities

- Ensures that the CCEO is timely informed of all key findings of internal compliance tests and assessments, audits, and monitoring initiatives.

- Undertakes to remain informed of relevant developments and trends in healthcare compliance and ethics by, among other things, attending seminars, reviewing professional

journals, and actively participating in professional organizations, and leverages that insight and knowledge to enhance the Program.

Auditing, Testing, and Monitoring-Specific Responsibilities

- Leads the day-to-day operations of the Program’s auditing, testing, and monitoring initiatives.

- Manages internal and external auditing, testing, and monitoring resources.

- Under the CCEO’s direction, develops and executes an Annual Auditing, Testing, and Monitoring Plan, and provides the CCEO with periodic updates as work streams are undertaken.

- Develops and performs audits and tests as needed in response to reported compliance and ethics concerns.

- Ensures that written evaluative reports of findings are developed for all initiatives undertaken.

- In collaboration with the appropriate business unit leader, develops and implements corrective action plans to address systemic issues or pervasive practices that could give rise to potential violations of applicable laws, regulations, or AMM’s Code of Conduct and/or policies and procedures.

- Develops and maintains auditing, testing, and monitoring metrics to report progress to the CCEO and the AMM Compliance Committee.

EDUCATION & EXPERIENCE

- Five to ten years of relevant professional experience in healthcare, preferably including a leadership role. Experience auditing healthcare claims in a professional services firm and/or in-house at a large healthcare provider organization, health system, and/or payer.

- An undergraduate degree; preference for Certified Public Accountant.

- Recommended top-tier healthcare audit certification, such as Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders (AAPC) along with a fundamental understanding of regulatory framework and coding practices.

- Fundamental understanding of government healthcare programs (i.e., Medicare and Medicaid).

- Demonstrated ability to work effectively with key internal and external stakeholders.

PROFESSIONAL PROFILE

Key Leadership and Management Skills

- A demonstrated ability to cultivate working relationships with representatives from government agencies.

- An ability to operate successfully in a flat culture, with the courage and competence to engage on multiple fronts and tackle challenges head-on.

- An ability to prioritize effectively, and exercise sound judgment, in a fast-paced, physician-driven environment.

- A demonstrated ability to accurately apply the necessary methodologies, professional standards, and government agency expectations for conducting healthcare auditing, testing, and monitoring activities.

Personal Characteristics

- Exemplary integrity with courage and an unwavering ethical compass.

- Pragmatic, risk-aware professional judgment.

- Demonstrated tact, trustworthiness, and diplomacy skills needed to manage sensitive and confidential information such as protected health information.

- An adept listener with a sense of humility.

- Capable of earning the respect and confidence of colleagues through demonstrated professional excellence and expertise.

AAP/EEO Statement

It is the policy of Advanced Medical Management to provide equal opportunity for all applicants and employees. The Company does not unlawfully discriminate on the basis of race, creed, color, religion, sex sexual orientation, gender, gender identity, national origin, ancestry, age, medical condition or genetic characteristic, physical or mental disability, family care or medical leave status, military status, pregnancy, marital or domestic partner status, veteran status, or any other status protected by state or federal law.

Job Type: Full-time

Pay: $120,000.00 - $150,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Long Beach, CA 90815 (Preferred)

Work Location: Hybrid remote in Long Beach, CA 90815