Manager, Internal Audit - 25-89

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees.  We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Under the direction of the Compliance Officer, the Manager of Internal Audit supports compliance across PriMed / Hill Physicians Medical Group (HPMG) / Hill Physicians Care Solutions (HPCS) by independently execute end-to-end internal audits, including performing effective risk assessments, planning, assessing the design of controls, testing the effectiveness of controls and reporting results to management.  This includes but is not limited to conducting compliance, operational, financial and system auditing activities, analyzing findings, identifying areas of risk, and recommending interventions based on audit results as it relates to compliance with industry standards including but not limited to (e.g. NCQA), contracts, billing and coding requirements, policies and procedures, contracts, and state and federal regulatory requirements across all regions. The Manager of Internal Audit is solutions oriented, critical thinker and will collaborate across the organization to ensure alignment and efficiency in audit strategy.

The Manager of Internal Audit is responsible for reviewing and evaluating the compliance, privacy, and operational areas/business units with compliance with the regulatory and contractual requirements. The position contributes to overall operating efficiency by ensuring adherence to effective and efficient operating procedures and by evaluating systems of internal control throughout the system. The incumbent assists in assessing the risk of loss or impairment of system assets and recommends internal controls and procedures to the Compliance Officer.

The Manager of Internal Audit is responsible for designing and implementing audit programs and communicates audit findings and recommendations to the Compliance Officer. The position obtains statistics and the information necessary to maintain an audit risk assessment system for all auditable areas. This individual must conduct audit work in compliance with the standards for the professional practice of internal auditing as identified by the Association of Healthcare Internal Auditors and Institute of Internal Auditors. He/she performs the role by demonstrating technical ability and an understanding of job expectations while working in compliance with organizational policies and procedures.

ESSENTIAL RESPONSIBILITIES:

Review and Evaluate Operating Areas of PriMed and Related Enterprise Partners

• Perform all aspects of internal audits, including assessing compliance risk, developing audit work-plans in collaboration with other departments, performing all audit work steps, documenting and reporting findings and recommendations, and following up to confirm findings are appropriately remediated. Areas of audit include, but are not limited to, Compliance, Privacy, FWA, Claims, Clinical Documentation, Medical Records, Coding and Billing, Utilization Management, Qulaity, Care Management, Network Practices, Sub-delegation, Corporate Compliance as well as compliance with policies and procedures, program descriptions, operational processes, etc.
• Conduct interviews, review documents, develop and administer surveys, compose summary memos, and prepare working papers.
• Develop, plan, and coordinate preparatory “mock” audits, including reviews of policies & procedures, DMHC & DHCS technical assistance guides (TAGs), CMS audit tools to conduct question and answer sessions, and lead departments through audit preparatory measures as needed.
• Implement audit work steps by preparing audit tools for audit scope in alignment with regulatory and delegation requirements, sending audit