Regulatory Affairs Internal Compliance Auditor Job in Boston 02108, Massachusetts Us

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Commonwealth Care Alliance, Inc. is a not-for-profit care delivery system committed to providing integrated health care and related social support services. Created in 2003, Commonwealth Care Alliance is a “consumer-governed” organization offering a full spectrum of medical and social services for people with complex needs covered under Medicaid and for those “dually eligible” covered by both Medicaid and Medicare, including:


Commonwealth Care Alliance is organized as a "consumer-governed care system” to ensure that the empowered consumer voice is built into all of our activities.


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REGULATORY COMPLIANCE AUDITOR

 

 

Position Summary:

 

Under the direction of the Regulatory Affairs Compliance Manager, the key roles of this position are:

 

·               To provide auditing and regulatory compliance expertise in maintaining an effective corporate compliance plan at CCA.

·               To develop, propose, implement and help maintain an Annual Internal Compliance Audit Plan and to perform audits in the execution of the Plan.

·               Conduct ad/hoc audits and assist/oversee other internal or external regulatory compliance audits   

 

This position is responsible for the development, implementation and maintenance of a complete, effective internal and external compliance and monitoring programs at CCA, which includes continuing to provide input and taking the lead in building build solid auditing methodologies, infrastructure and best practices; and develop annual compliance risk assessment based on regulatory requirements and focus areas which inform the annual Internal and External Compliance Audit Plans.  Regulatory Compliance Auditor plays a critical role in supporting the overall Regulatory Affairs Compliance infrastructure at Commonwealth Care Alliance.

 

ESSENTIAL ROLES AND RESPONSIBILITIES:

 

CCA’s Annual Compliance Audit Program:

                                   

·               In conjunction with Manager, assume overall responsibility for the internal and external auditing and monitoring program;

·               Maintain current knowledge of and identify regulatory compliance risk using various sources, including but not limited to Centers from Medicare and Medicaid Services (CMS), CMS conferences, HPMS Guidance, CMS Publically Posted CAPs, and the Office of Inspector General (OIG) Annual Work Plan. Perform medium to complex end-to-end Compliance Risk Assessment minimally on an annual basis, or more often as needed;

·               Lead effort for CCA’s Annual Internal Compliance Audit Plan:

·               As part of Regulatory Affairs and Compliance team, assist in the oversight of the corporate compliance plan and the identification of compliance risks;

·               Establish and implement procedures and a system for promptly responding to compliance issues as they are raised, investigating potential compliance problems as identified in the course of self-evaluations and audits, overseeing/driving activities to correct such problems promptly and thoroughly to reduce the potential for recurrence and ensure ongoing compliance with CMS requirements;

·               Maintain the Regulatory Data Base Tool for internal audit documentation, including reports, findings, recommendations, Corrective Action Plans from CCA’s Delegated Entities, and Improvement Action Plans submitted by business leads to Regulatory Affairs and Compliance.

 

Regulatory Compliance Infrastructure: 

 

·               Provide consultation with business owners  in developing policy and procedures to ensure internal controls of high risk regulatory requirements are in place and are working effectively;

·               In conjunction with Senior Compliance Specialist, monitor and audit compliance with CCA policies and procedures on an ongoing basis, including, but not limited to, delegate oversight, Part C and Part D regulations, SCO regulations, SNP regulations, OIG,  HIPAA/HITECH, False Claims Act;

·               Support business  units in interpretation of regulations related to their  areas as well as provide assistance in developing appropriate tools to ensure compliance;

 

Additional Responsibilities:                         

                       

·               Submit Certification of Enrollment certification in collaboration with Finance;

·               Conduct HIPAA Privacy Audits;

·               Review and analyze MassHealth Publications, HPMS Memorandums and OIG publications as requested;

·               Provide Committee support when requested.  This would include note taking and assisting with meeting materials and logistics;

·               Manage effective communication with multiple business areas and staff;

·               Ensure confidentiality of member information is maintained;

·               Take part in all required trainings, included annual compliance-related trainings; and

·               Perform other duties as required

 

Requirements:

 

·               Bachelor’s Degree - Advanced Degree Preferred**

·               3-4 years’ work experience in health care required. A background in internal auditing or regulatory compliance is preferred.  2-3 years’ experience with internal auditing is required.

·               Minimal travel may be required.

 

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