MSO Compliance & Audit Coordinator
Company: North East Medical Services
Location: Daly City
Posted on: September 21, 2023
The Managed Care Compliance and Audit Coordinator will work
closely with the Managed Care Compliance and Audit Manager to
assist with compliance and auditing functions of NEMS MSO
(Management Services Organization), including, but not limited to,
internal and external audit activities to the Claims, UM,
Credentialing, CM functions, and quality improvement initiatives.
This role will also be responsible for monitoring regulatory
requirements and understanding how requirements impact MSO
operationsESSENTIAL JOB FUNCTIONS:
- Conduct internal audits to systematically assess the
department's risks and efficacy of delegated functions and
activities, policies, and procedures, using assessment and auditing
tools approved by contracted health plan and/or developed
- Coordinate inter-department and cross-department level projects
including planning, workgroup meetings, collecting and setting
agenda items, creating meeting minutes, and following up with
- Assist with administrative tasks from the MSO Compliance and
Audits (C & A) and QI team. The C & A Team and QI team are separate
units but work collaboratively to promote quality assurance and
quality improvement activities.
- Collaborate with different MSO units, including Claims, UM,
Provider Relations, Care Management, and Data Reporting, to relay
compliance requirements, audit scores, corrective action plans, and
to ensure non-compliance area(s) is corrected and monitored.
- Work closely with MSO C & A manager, department managers, and
external health plan auditors with compliance audit activities,
including but not limited to internal and external of communication
about audit calendar/schedule and level of requirement, report
submission, gathering of documents, etc., to facilitate a smooth
and positive audit experience from external auditors.
- Analyze regulatory guidance documents, document requirements,
understand & communicate requirements, and collaborate with
different teams to monitor compliance.
- Collaborate with different teams and departments to ensure
compliance with NCQA standards as NEMS works towards NCQA
- Performs other job duties as required by
- Bachelor's degree in relevant field is required.
- Experience in a healthcare setting or managed care is
- Previous experience in quality assurance and quality
improvement related activities in healthcare related setting is a
- Knowledge of NCQA standards and guidelines is a plus.
- Strong knowledge of Microsoft Office (PowerPoint, Word, Excel,
- Excellent communication skills, both written and verbal.
- Ability to multi-task and work with highly sensitive and
- Excellent problem-solving skills and be able to think
- Excellent interpersonal and customer service skills.
- Ability to work with all levels of staff.LANGUAGE:
- Must be able to fluently speak, read and write English.
- Fluent in Chinese (Cantonese and/or Mandarin) preferred
- Fluency in other languages are an asset.STATUS:This is an FLSA
This is not an OSHA high-risk position.NEMS is proud to be an Equal
Opportunity Employer welcoming diversity in our workforce. Pursuant
to the San Francisco Fair Chance Ordinance, we will consider for
employment qualified applicants with arrest and conviction
records.NEMS BENEFITS: Competitive benefits, including free
medical, dental and vision insurance for employee, spouse and/or
children; and company contribution to 401(k).
Keywords: North East Medical Services, Daly City , MSO Compliance & Audit Coordinator, Accounting, Auditing , Daly City, California
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