Health Program Auditor and Health Program Audit Manager Series

California State Personnel Board Specification

Series established August 31, 1982

Scope

This series specification describes classes used in the Department of Health Services. These classes perform, supervise, and manage professional auditing work in accordance with departmental audit standards to assure compliance with the Federal and State laws and regulations governing the various health programs. These classes also preside at informal administrative hearings resulting from audits, investigations and medical reviews, involving financial assessments and settlement grievances between health programs administered by various departments and contract providers of services.

Positions in the Health Program Auditor series administer, supervise, manage or conduct management, financial, and internal audits and investigations of hospitals, nursing homes, prepaid health plans, adult day health centers, organized health systems, pilot projects, family planning clinics, rural and Indian health clinics, departmental programs, site mitigation and other contractors and fiscal intermediaries; perform special and complex reviews of health care maintenance organizations; determine and obtain compliance with Federal and State laws and regulations governing various program contractors, preventive health programs and Medi-Cal reimbursements; conduct informal appeal hearings including controlling the course of the hearing, reviewing evidence in written form, examining testimony, and preparing reports of findings and recommending proposed decisions; serve in a staff or supervisory capacity to develop and interpret audit and compliance procedures and review and analyze the fiscal and program impact of pending legislation on the Department's various health programs; and provide expert testimony at hearings related to disputed audit findings.

Entry Level

Entry into this series is typically through the Auditor I class.

Factors Affecting Position Allocation

The number and level of subordinate staff, scope and consequence of decisions made, degree of program and policy involvement, sensitivity and complexity of work assignments, independence of action, and size, fiscal impact and nature of audit area.

Definition of Levels

Health Program Auditor II, Department of Health Services

This is the first journey level in the series. Under direction, incumbents independently conduct technical management, financial, and internal audits of moderate difficulty or under the lead of a Health Program Auditor III conduct portions of more complex audits. Incumbents plan the scope and procedure of audits; correspond and discuss with health program providers and contractors regarding application of the related laws and regulations; or conduct program audits to assess the financial and administrative capabilities of health care providers and departmental programs.

Health Program Auditor III, Department of Health Services

This is the second and full journey level requiring independence and proficiency in conducting and evaluating complex and difficult fiscal, management and internal audits of various health programs, health facilities, health maintenance organizations, fiscal intermediaries, site mitigation and other contractors, internal management controls, and individuals subject to State and Federal laws and regulations which govern the Department's health programs; or to assist in audit program evaluation and in the development and improvement of health program audit methods and techniques; or conduct administrative hearings involving financial assessments in accordance with the California Administrative Code and related Federal regulations; perform case research and evaluation duties, review evidence, examine testimony and prepare proposed decisions; and present findings in formal hearings and court proceedings.

Health Program Auditor IV, Department of Health Services

This is the advanced journey or specialist level. Positions at this level are characterized by assignment of only the most complex and comprehensive health program audits, audit appeals, and compliance issues and where the highest degree of judgment must be exercised in the application of laws, rules, regulations and audit procedures.

Incumbents, under general direction:

1. Serve as an independent staff specialist, prime resource, and innovator in new audit and/or compliance program development, implementation, monitoring, and evaluation.

2. Interface with other agencies, organizations, fiscal intermediaries, site mitigation and other contractors, individuals, and corporations where health program audit and compliance expertise is required and the highest degree of judgment must be exercised in the application of State and Federal laws, rules, regulations, and audit and appeal procedures.

3. Conduct or review very large, complex and sensitive audits characterized by having major fiscal impact and a complex organizational structure (i.e., larger statewide and national organizations or multilayered contractor/subcontractor).

4. Conduct the most complex and sensitive administrative hearings involving financial assessments and settlement grievances, sensitive and complex policies, substantial amounts of funds; and controversial regulation interpretations.

Health Program Audit Manager I, Department of Health Services

This is the first supervisory level in the series. Under direction, incumbents either (1) supervise a unit of auditors in a regional office conducting field audits of a moderate to high level of difficulty; or (2) in a headquarters setting, supervise an audit unit responsible for (a) final review of complex field audits, review of audit appeals or headquarters audit support functions, (b) an audit unit reviewing site mitigation and other contracts, (c) an audit unit conducting reviews of internal management controls; organizational policies and procedures; and fiscal systems; or (3) supervise a unit of auditors and support staff responsible for conducting hearings and making decisions on appeal cases.

Health Program Audit Manager II, Department of Health Services

This is (1) the second supervisory level responsible for directing, through multiple subordinate supervisors, the audit program in a large regional office or (2) a headquarters audit appeal, support or hearing operation.

Health Program Audit Manager III, Department of Health Services

This is the management level with responsibility for managing the auditing and staff functions through subordinate supervisors on a subfunctional and/or geographic basis.

Minimum Qualifications

All Levels:

Education: Either

1. Equivalent to graduation from college with specialization in accounting; or

2. Completion of either:

a. A prescribed professional accounting curriculum given by a residence or correspondence school of accountancy including courses in elementary and advanced accounting, auditing, cost accounting, and business law; or

b. The equivalent of 16 semester hours of professional accounting courses given by a collegiate grade residence institution including courses in elementary and advanced accounting, auditing and cost accounting, and three semester hours of business law.

Health Program Auditor II, Department of Health Services

Either I

One year of experience in the California state service performing professional health program accounting or auditing duties at a level of responsibility equivalent to that of Accountant Trainee, Accountant I, or Auditor I. (Applicants meeting the educational requirements who have completed six months of service performing the specified duties will be admitted to the examination, but they must satisfactorily complete one year of this experience before they can be considered eligible for appointment.)

Or II

Experience: Two years of health program auditing experience equivalent in responsibility to that involved in making less difficult technical audits in government, commercial, public or health program auditing performing analytical or critical examination of health program records or books of accounts with responsibility for laying out audit programs and determining the scope of work to be performed. (Bookkeeping, clerical, accounting, preauditing, procedure checking, and system maintenance experience is not acceptable.) and

Education: The educational requirements described above.

Health Program Auditor III, Department of Health Services

Either I

One year of experience in the California state service performing professional health program accounting or auditing duties of a class with a level of responsibility equivalent to that of Health Program Auditor II, Department of Health Services. (Applicants who have completed six months of service performing health program accounting or auditing duties of a class with a level of responsibility equivalent to that of Health Program Auditor II, Department of Health Services, will be admitted to the examination, but they must satisfactorily complete one year of this experience before they can be considered eligible for appointment.)

Or II

Experience: Three years of increasingly responsible professional health program accounting or auditing experience including at least one year conducting a variety of complex health program audits or financial examinations. (Experience in California state service applied toward this requirement must include at least one year performing the duties of a class with a level of responsibility equivalent to that of Health Program Auditor II, Department of Health Services.) and

Education: The educational requirements described above.

Health Program Auditor IV, Department of Health Services

Either I

One year of experience in the California state service performing professional health program accounting or auditing duties of a class with a level of responsibility equivalent to that of Health Program Auditor III, Department of Health Services.

Or II

Experience: Four years of increasingly responsible professional health program accounting or auditing experience including at least one year conducting a variety of complex audits or financial examinations. (Experience in the California state service applied toward this requirement must include at least one year performing the duties of a class with a level of responsibility equivalent to that of a Health Program Auditor III.) and

Education: The educational requirements described above.

Health Program Audit Manager I, Department of Health Services

Either I

One year of experience in the California state service performing professional health program accounting or auditing duties of a class with a level of responsibility equivalent to that of Health Program Auditor III, Department of Health Services.

Or II

Experience: Four years of increasingly responsible professional health program accounting or auditing experience including at least one year supervising a variety of complex audits or financial examinations. (Experience in the California state service applied toward this requirement must include at least one year of experience at the level of responsibility equivalent to a Health Program Auditor III, Department of Health Services.) and

Education: The educational requirement described above.

Health Program Audit Manager II, Department of Health Services

Either I

One year in the California state service performing the duties of a Health Program Audit Manager I, Department of Health Services, or a Health Program Auditor IV, Department of Health Services.

Or II

Experience: Five years of increasingly responsible professional health program accounting or auditing experience including at least two years supervising a variety of complex audits or financial examinations. (Experience in the California state service applied toward this requirement must include at least one year performing the duties in a class at a level of responsibility equivalent to Health Program Audit Manager I, Department of Health Services.) and

Education: The educational requirements described above.

Health Program Audit Manager III, Department of Health Services

Either I

One year of experience in the California state service performing the duties of a Health Program Audit Manager II, Department of Health Services.

Or II

Experience: Broad and extensive (more than five years) professional health program accounting or auditing experience including at least one year in a full managerial capacity. (Experience in the California state service applied toward this requirement must include at least one year performing the duties of a class at a level of responsibility equivalent to Health Program Audit Manager II, Department of Health Services.) and

Education: The educational requirements described above.

Knowledge and Abilities

Health Program Auditor II, Department of Health Services

Knowledge of: General auditing and accounting principles and procedures; business law; State and Federal laws and regulations which govern the Medi-Cal Program, Title XVIII of the Social Security Act; Title XIX of the 1965 Social Security Act, as amended; Medicare Program Regulations Manual; Skilled Nursing Facility Manual; Provider Reimbursement Manual; Welfare and Institutions Code, Section 14170; State of California Health and Safety Code; Title 22, Division 3 and 5 of the California Administrative Code; the California Health Facilities Commission Accounting and Reporting Manual for Long-Term Care Facilities; Title 42-Code of Federal Regulations; Fiscal Intermediary Manual; and the Government Code, Title 2, Division 3; legal opinions and court decisions as they relate to departmental programs, auditing practices and procedures as used in the various audit programs in the Department, and related departmental policies and procedures.

Ability to: Apply auditing principles and procedures; apply the State and Federal rules and regulations which govern the various departmental programs in the conduct of audits or financial examinations; apply legal opinions, court decisions, and departmental policies and procedures; establish and maintain cooperative working relations with those contacted during the course of the work; analyze situations accurately and adopt an effective course of action; reason logically and creatively in unique situations; speak and write effectively; testify at hearings on disputed audit findings.

Health Program Auditor III, Department of Health Services

Knowledge of: All of the above, and Health and Safety Code, Division 20 and EPA requirements regulating the control of hazardous materials; the State Administrative Manual provisions related to contracts; Federal cost reporting requirements, California Public Contract Code, Federal acquisition regulations; the health delivery systems administered by the Department of Health Services; operational aspects of major contracts subject to audit by the Department; specialized and complex program auditing practices and procedures: electronic data processing systems relative to health program and contractor's accounting methods; organization and operation of the Department's programs.

Ability to: All of the above, and negotiate successful program and contractor audit issues of average difficulty; read, understand, and evaluate computerized cost reports; adjust and modify work plan to meet changing conditions; write major sections of a complex and difficult audit; or for an audit of average difficulty write a complete audit report with recommendations.

Health Program Auditor IV, Department of Health Services

Knowledge of: All of the above, and the California Administrative Procedures Act; the most comprehensive knowledge of State and Federal laws, rules and regulations which govern the various departmental health programs and/or contractors subject to audit; specialized knowledge of financial, health program and contractor activity.

Ability to: All of the above, and handle the most difficult, complex, and comprehensive health program audit issues; write complete audit reports; independently function with general or limited guidelines; develop, implement, monitor, and evaluate new health audit programs; exercise the highest degree of judgment in applying laws and audit procedures.

Health Program Audit Manager I, Department of Health Services

Health Program Audit Manager II, Department of Health Services

Health Program Audit Manager III, Department of Health Services

Knowledge of: All of the above, and principles, practices, and trends of public and business administration, including management and supportive staff services such as budget, personnel, management analysis, planning, program evaluation or related areas; principles and practices of employee supervision, staff development and training, and employer-employee relations; program management; formal and informal aspects of the legislative process; departmental affirmative action goals; departmental administrative goals and policies.

Ability to: All of the above, and apply general accounting and auditing principles and procedures as used in the Department's various audit programs; plan, organize, and direct the work of a staff engaged in conducting audits; develop the skills and abilities of subordinate staff; understand individual and group relationships; effectively utilize interdisciplinary teams in the conduct of audit programs; propose solutions to and resolve complex supervisorial and managerial problems; manage the audit programs' personnel and training programs; take appropriate employee disciplinary action; and effectively contribute to the Department's affirmative action goals.

Special Requirements

All employees must be able to qualify for a fidelity bond and be willing to travel and work away from the office.

Health Program Auditor and Health Program Audit Manager Series.

Class History