625 State St, Schenectady, NY 12305, USA Req #74
Thursday, August 29, 2019
This position will be primarily responsible for performing independent and objective auditing and monitoring of the Company to ensure compliance with all applicable laws, regulations and policies/procedures. Independent auditing and monitoring includes: conducting audits and monitoring, analyzing results, recommending corrective actions, creating reports, educating and following up with the business areas to ensure the implementation of corrective actions. This position holds primary responsibility for planning, performing and reporting on audits that are focused on Medicare operations. Compliance auditing of other MVP products and/or topics is required at the discretion of Leadership. Creates tools to plan, coordinate, and perform audits and monitoring of the business areas based on guidance from CMS or other regulatory agencies. Determines testing methodologies and sample sizes. Performs audits of vendors, first tier or downstream and related entities to ensure compliance with all applicable CMS requirements or other laws, regulations, regulatory obligations and policies. Performs routine auditing and monitoring of business areas/operations to determine compliance with CMS and other regulatory requirements. Identifies, analyzes and researches findings. Makes recommendations to improve policies/procedures and processes so that the business areas are in compliance with CMS program requirements or other legal requirements. Communicates the results of audits and monitoring via professionally written reports. Reports must be clear, concise and accurate. Establishes and maintains electronic work papers for each audit including results and supporting documentation. Communicates the findings and recommendations to the business areas as directed. Prepares audit and monitoring results in the appropriate format to clearly communicate and identify trends from a compliance/risk perspective. Ensures findings and/or recommendations are addressed by working cooperatively with the responsible departments. Analyzes and interprets compliance data to identify areas for future audits and monitoring. Presents audit and monitoring reports to Leadership, Compliance Department or others as directed. Creates and modifies corporate compliance and departmental policies and procedures as directed by Leadership. Assists and supports compliance-related projects and initiatives as assigned. Participates collaboratively in staff meetings, committees, projects and teams to resolve issues and meet compliance program goals; and other duties as assigned.
Bachelor’s degree required.
• A minimum of 2 years auditing experience required in managed care, compliance auditing or health insurance compliance auditing.
• Clear, concise and accurate audit report writing and presentation skills.
• Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.
• Decisive and exercises good judgment under pressure.
• Demonstrated ability to work and communicate effectively with employees at all levels.
• Strong organizational skills.
• Strong orientation to deadlines and details.
• Excellent interpersonal, analytical and communication skills.
• Ability to meet competing deadlines.
• Experience in Microsoft Word, Excel, and PowerPoint
• Ability to analyze and trend data to develop value-added reports.
• Demonstrated understanding and experience in auditing CMS, Medicaid, operational standards and other regulatory requirements
• Experience with the FACETS and MACESS
• Experience with Business Objects or Cognos
• Certified Internal Audit (CIA) or Certified in Healthcare Compliance (CHC)
- Job Family Legal
- Pay Type Salary
- 625 State St, Schenectady, NY 12305, USA