Sr. Director, Internal Audits - Community Health Choice
Harris Health System
Location: Houston, Texas
Type: Full Time
Internal Number: 162928
The Sr. Director, Internal Audits is responsible for overseeing all ongoing activities related to the development, implementation, and maintenance of Community's Audit Program. Oversee and manage efforts for the internal audit program that ensures the soundness of internal controls over key financial and operational processes, including IT General Controls. Responsible for oversight of the internal audit department staff and monitoring the Model Audit Rule (MAR) Compliance Program. Responsible. Plan and manage the audits related to oversight of the Delegated Entities (Delegation Oversight). Responsible for planning and execution of for operational, compliance and ad hoc audits throughout the organization to ensure Community's operations and processes are compliant with laws and regulations. Responsible for validation audits to confirm implementation of Corrective Action Plans or Regulatory changes to processes within the organization. Ensure that audits cover all lines of business (Star, Marketplace, CHIP and D-SNP) either separately on in a clustered review.
Must maintain open lines of communication with internal partners, regulators, vendors and other internal or external partners to assure collaborative working relationships. Provides direct support to the Chief Compliance Officer, focusing on the ongoing monitoring of control processes across all product areas and functions within the organization. Assists Compliance Regulatory Affairs and Compliance Operations in the readiness preparation for external audits. Development of policies and procedures and corrective action plans to ensure that Community's Internal Audit, Risk Management and operational and compliance audit programs function efficiently and effectively. Responsible for producing on a monthly, quarterly and/or annually basis risk reports based on the data originating from audit results as well as from selected metrics from organization's Key Performance Indicators. Supports Enterprise Risk Management report production as directed by the CCO.
Presents audit and risk results the Regulatory Affairs Compliance Committee and Executive Compliance Committee.
Develop and maintain a professional team approach with both external and internal partners to achieve accurate results and the organizations strategic goals.
BA/BS degree (Masters preferred); CIA or CPA
Eight years previous experience in Compliance, Risk Management and/or Auditor role. Preferred experience in managed care organization.
Four years management experience in a healthcare preferably managed care organizations.
Ability to maintain an attitude of independence and objectivity towards all internal and external partners.
Ability to organize tasks and work independently.
Knowledge of statistics and sampling methodology.
Knowledge of billing (professional and facility) and coding (CPT, ICD-10, HCPCS, DRG)
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.