San Francisco Health Plan

  • Audit Analyst

    Job Locations US-CA-San Francisco
    Job ID
    Compliance and Regulatory Affairs
    Regular Full-Time
  • Overview


    Are you ready to make a difference in San Francisco? We have an exciting opportunity for the audit professionals!


    Under the general direction of the Supervisor, Compliance Programs, 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 various internal department processes
    • Developing audit tools, audit reports, and criteria metrics
    • Communicating effectively and efficiently with internal and external clients regarding auditing and monitoring activities



    • Ensure compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommend opportunities to strengthen the internal control structure.
    • Assist the Supervisor, Compliance Programs 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; present 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.
    • Enhance compliance department and organization reputation by accepting ownership for accomplishing new and different requests; explore opportunities to add value to job accomplishments.
    • 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.
    • Regularly 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 and participate in the SFHP Anti-Fraud Workgroup.
    • Support and participate in the development of the Annual Anti-Fraud 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.
    • Monitor regulatory, industry, and compliance climate and escalate issues when necessary.
    • Maintain a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting publicly-funded managed care organizations.
    • Maintain knowledge of business products and related SFHP policies and procedures.



    • Bachelor’s degree in business administration or closely related field, or equivalent experience
    • Three years of experience in health care industry and operations desired
    • Specialized knowledge in state programs, regulatory compliance and antifraud activities, required
    • Certification in health care compliance preferred
    • Certified Professional Coder (CPC) desired.
    • Ability to analyze varying and large amounts of data to extrapolate meaning and use; detect and report on findings and trends, and support conclusions and recommendations using valid sources of data
    • Excellent oral and written communication skills required; strong knowledge and application of English grammar including composition, editing and proofreading skills
    • Strong time management and project management skills and multi-tasking abilities
    • Intermediate level proficiency with MS Office applications (Word, Excel, PowerPoint, Sharepoint) with expertise with word processing, spreadsheets, graphics and presentation software including the ability to create tables; merge documents; and develop graphics and PowerPoint presentations from notes





    Established in 1997, San Francisco Health Plan (SFHP) is a 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. San Francisco Health Plan is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 142,000+ 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 an Equal Opportunity Employer (EOE M/F/D/V)


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



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