The Senior Compliance Auditor supports Umpqua Health Alliance’s compliance with the Oregon Health Authority (OHA) Coordinated Care Organization (CCO) contract by overseeing key audit, monitoring, and regulatory functions. This position plays a central role in coordinating external audits, maintaining compliance with applicable state and federal Medicaid regulations, and implementing corrective actions resulting from regulatory findings. The role requires a CHC certification and at least five years of healthcare compliance or audit experience, preferably in a Medicaid managed care environment.

Essential Duties and Responsibilities:

• Manage and coordinate all activities related to the External Quality Review (EQR) conducted by the state’s designated External Quality Review Organization (EQRO), including document production, stakeholder coordination, timeline tracking and audit facilitation.
• Conduct compliance audits of provider groups identified by UHA’s Special Investigations Unit (SIU) for potential fraud, waste, and abuse (FWA), ensuring adherence to applicable Oregon Administrative Rules (OARs), federal regulations, and contractual requirements.
• Maintain working knowledge of the Oregon CCO contract, applicable sections of the Code of Federal Regulations (CFR), and Oregon Administrative Rules (OARs) governing CCO compliance.
• Track and interpret compliance requirements under 42 CFR §438 Subpart E, ensuring organizational readiness for external audit and performance review activities.
• Coordinate internal assessments to validate compliance with CCO contractual obligations, performance measures, and reporting deliverables.
• Lead or support corrective action planning and remediation activities in response to findings from OHA, EQRO, or other oversight bodies.
• Facilitate internal control documentation, risk assessments, and testing to ensure ongoing operational compliance with state and federal Medicaid requirements.
• Respond to regulatory inquiries, audit requests, and OHA monitoring activities, including gathering supporting documentation and ensuring consistency in external responses.
• Collaborate with operational teams to develop and document processes that fulfill contract-required activities, including care coordination, grievance systems, access standards, and quality improvement.
• Maintain compliance tracking tools and develop reports that highlight key risk indicators, audit status, and compliance trends.
• Serve as the compliance liaison to all subcontracted entities, supporting contract compliance, data requests, monitoring activities, and issue resolution
• Participate in cross-functional committees and workgroups to ensure coordination of compliance-related deliverables and communication of regulatory changes.
• Develop and deliver training on contractual and regulatory compliance topics, including annual updates related to EQR protocols and audit expectations.
• Support the development and submission of contract deliverables related to EQR, performance improvement projects (PIPs), compliance monitoring, and grievance system validation.
• Ensure compliance with all applicable state and federal laws.

• CHC (Certified in Healthcare Compliance) required.
• At least five (5) years of healthcare compliance or auditing experience, with significant experience in Medicaid managed care.
• Knowledge of OHA’s CCO contractual requirements, 42 CFR §438, and Oregon’s Medicaid regulatory framework.
• Experience coordinating or supporting EQR, CMS audits, or state performance reviews.
• Demonstrated ability to interpret and apply complex regulatory and contractual language to operational processes.
• Strong writing, organization, and project management skills; ability to manage multiple deadlines with minimal oversight.

• Bachelor’s degree in Public Health, Healthcare Administration, Business, or a related field.
• Experience working directly with or for an Oregon CCO, EQRO, or state Medicaid agency.
• Familiarity with Oregon Administrative Rules, CCO audit protocols, and contract deliverable tracking systems.

About Umpqua Health

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Umpqua Health serves Douglas County, Oregon, where we prioritize personalized care and innovative solutions to meet the diverse needs of our members. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.