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Human Resources Department
#22-123010-02
Supplemental Questionnaire

Last Name First Name
 

 

This Supplemental Questionnaire will be used to determine applicants’ qualifications for this position and assess an applicant’s ability to advance in the recruitment process; therefore, applicants are encouraged to answer all questions thoroughly and completely.  Omitted information will not be considered or assumed.  Applicants who have no experience in a specific area are recommended to state 'no experience in this area' instead of leaving the space blank.

Please note that the experience in your answers must be reflected in your employment history.
1.

How many years of experience do you have performing compliance responsibilities in a health care or health insurance setting?
No Experience
Less than two years’ experience
Two to four years’ experience
More than four years' experience
2.

Do you have experience conducting audits of any of the following within a health care or health insurance setting:
Medi-Cal Program Audit
Medical Chart Audits
Department of Health Care Services (DHCS) Program Audits
Health Resources and Services Administration (HRSA) Audits
No experience conducting these types of audits.
3.

How many years of experience do you have analyzing data and writing reports that examines patterns and trends within a health care or health insurance setting regarding quality, safety, privacy and security events?
No Experience
Less than two years’ experience
Two to four years’ experience
More than four years' experience
4.

Do you have experience performing duties in which you identified and investigated provider and provider fraud, waste, and abuse in a health care or health insurance setting?
No Experience
Less than two years’ experience
Two to four years’ experience
More than four years' experience
5.

Do you have experience performing duties in which you identified and investigated privacy breaches, security incidents, or violations of policy in a health care or health insurance setting?
No Experience
Less than two years’ experience
Two to four years’ experience
More than four years' experience
6.

Check all certifications which you hold:
Certified Information Privacy Professional (CIPP)
Certified Information Privacy Manager (CIPM)
Certified Information Privacy Technologist (CIPT)
Certified Information Systems Security Professional (CISSP)
Healthcare Information Security and Privacy Practitioner (HCISPP)
Certified in Healthcare Compliance (CHC)
Certified in Healthcare Privacy Compliance (CHPC)
Certified in Healthcare Research Compliance (CHRC)
Certified in Health care Privacy and Security (CHPS)