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You can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Audit Analyst.

Reporting to the Senior Manager, Compliance and Oversight, the Audit Analyst is responsible for supporting the San Francisco Health Plan (SFHP) Compliance Program through audit and monitoring activities.

Responsibilities include:

• Auditing and monitoring external provider and vendor entities.
• Auditing and monitoring various internal department processes.
• Developing audit tools, audit reports, and criteria metrics.
• Communicating effectively with internal and external clients regarding auditing and monitoring activities.

WHAT YOU WILL DO

• Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommending opportunities to strengthen the internal control structure.
• Assist the Manager, Compliance and Oversight in development and implementation of Annual Audit Workplan.
• Complete audit work papers and memorandums by documenting audit tests and findings.
• Communicate audit progress and findings by preparing reports; presenting information in various formats, including in-person meetings.
• Prepare special audit and control reports by collecting, analyzing, and summarizing operating information and trends.
• Provide management reports by collecting, analyzing, and summarizing management information.
• Investigate leads generated by anti-fraud software platform, maintain caseload and provide summary reports to management.
• Assist in the monitoring of SFHP’s policies and procedures with strong working knowledge of policy development and approval process.
• Consult in the development and monitoring of corrective action plans to mitigate risks.
• Schedule and attend meetings with management to communicate audit findings, discuss identified risks, and explore suitable solutions.
• Assist with the coordination of external audits, providing documentation, and other administrative support.
• Support the SFHP Program Integrity Workgroup.
• Conduct routine and focused provider and member investigations.
• Support the development of the Annual Program Integrity Workplan and regulatory reports.
• Train and assist various departments in developing best practices in their operations in accordance with established policies and procedures.
• Provide support to the Compliance hotline and assist in the investigation and research of allegations of HIPAA violations, fraud waste and abuse, and other compliance issues.

WHAT YOU WILL BRING

• Bachelors Degree in business administration or closely related field, or equivalent experience.
• Certified in one of three (3) areas: Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), or Certified Internal Auditor (CIA) preferred.
• Minimum of 5 years of experience in health care industry and operations or in related audit functions
• Specialized knowledge in state programs, regulatory compliance and antifraud activities required.
• Certification in health care compliance preferred.

BENEFITS:

• Medical Plans: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans are currently available at no cost and dependent coverage is heavily subsidized by SFHP.
• Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision: Employee vision care coverage is available at no cost.
• Time Off: 23 days of Paid Time Off and 12 observed company holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT US:

Established in 1994, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 170,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.