Manager, Controls & Compliance - The Health Plan

 
Position: Manager, Controls & Compliance - The Health Plan

Job ID: 149031

Location: US-TX-Bellaire

Department: Controls & Compliance

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Controls and Compliance Manager — someone who works well in a fast-paced setting. In this position, you'll ensure that the organization has effective internal controls in high risk areas which serve to: mitigate risk of fraud, abuse, errors, and omissions, and promote compliance with federal/state laws/regulations, contractual obligations, and corporate policies/procedures.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

HOU123

  • Develops and annually updates a work plan to access the effectiveness of existing internal controls in high risk areas
  • Develops and annually updates a Fraud and Abuse Plan and related work plan
  • Performs multi-project management duties in the planning, scheduling, and coordinating of work that is performed by staff
  • Ensures preparation of project risk assessment, scope of work, and work plan procedures to accomplish objectives
  • Identifies all departments and leadership that may be impacted to ensure communication and involvement in each evaluation, audit, and consulting activity
  • Performs on-going reviews of department work papers, findings, recommendations, and reports to ensure that documentation is sufficient, competent, and relevant evidence exists to support the department’s work objectives
  • Monitors progress for completion of projects within established timelines through direct supervision of staff, staff meetings
  • Performs highly advanced and specialized financial, operational, and compliance projects, consulting, and investigations that either exceed the staff’s experience, knowledge, and skills, or demand the highest confidentiality and discretion
  • Collaborates with Health Plan leadership, the director, audit services of the IDS, and director of compliance of the IDS to complete an annual risk assessment covering financial and operational scope, taking into account industry risks, mission, and strategic plan
  • Oversees Special Investigations Unit, which conducts investigations of provider fraud, abuse, and waste

 



Qualifications:

Skills & Requirements

 

  • Bachelor’s degree from an accredited four-year college or university with emphasis in any of the following: accounting, auditing, business administration, information systems, research/data analysis, or other healthcare or business related field of study
  • One of the following is required: CPA - Certified Public Accountant OR CISA – Certified Information Systems Auditor OR CIA -- Certified Internal Auditor OR EDUHRUSE - EDU HR USE Juris Doctorate
  • 5 years of related work experience is required
  • Knowledge of generally accepted accounting principles; statutory accounting, insurance, and HMO regulations, Medicaid and CHIP programs; and claims payment software

 



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