POSITION SUMMARY /RESPONSIBILITIES
Community First Health Plans (Community First) is an HMO providing Health Care Services to Medicaid and CHIP recipients. Community First also provides commercial and self-funded insurance to our members. Community First must ensure that all operations are aligned with regulatory requirements of the Texas Health and Human Services Commission (HHSC) and the Texas Department of Insurance (TDI), the Centers for Medicare and Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC). Collaborates with all leaders and departments throughout the course of the audit function promoting a team-oriented environment.

EDUCATION/EXPERIENCE
Bachelor’s degree in Accounting or Healthcare related field with at least five years’ experience in interpretation of Texas Medicaid Managed Care regulations, Texas Department of Insurance regulations, and/or HHSC OIG Medicaid Managed Care SIU regulations. Experience with anti-fraud detection and prevention required. Three years supervisory experience is preferred. Experience with SEC SOX and/or NAIC MAR audits. Experience with Enterprise Risk Management (ERM). At least three years professional healthcare audit experience required. Must possess at least one or more relevant professional certifications (i.e., CHC, CIA, CPA, CFE). Preference will be given to a Certified Internal Auditor with AHIMA Coding Certification. Expert knowledge of ICD, CPT, HCPCS coding classifications and DRG, APC and ASC payment methodology required.