Compliance Program Auditor

Job DescriptionJob Description

The Compliance Auditor is expected to assist the Director of Compliance and Vice President of Compliance in all areas of corporate compliance. The Compliance Auditor is expected to conduct program audits, manage projects and perform additional duties as deemed appropriate by the Director of Compliance.

Required:

1. Knowledge of auditing principles and risk assessment processes.
2. Strong organizational, verbal and written communication skills.
3. Ability to multi-task, manage projects and produce deliverables within established time frames.
4. Intermediate to advanced knowledge of Microsoft Office systems – Word, Excel and PowerPoint and the ability to learn other software systems.
5. Must be able to work independently.

Desired:

1. College degree with courses in business, health care law, health care reimbursement, health care administration or comparable experience in health care compliance and/or health plan operations.
2. Experience in managed care or health care compliance, with emphasis in corporate compliance, Medicare Advantage, Medicaid, marketing, enrollment, pharmacy compliance, customer service, provider relations and/or HIPAA privacy.
3. Experience in navigating health care regulations such as those issued by Medicare, Medicaid and the Affordable Care Act.
4. Certified in health care compliance or comparable certification, or if not certified, willing to become certified.

Responsibilities:

1. Assist in the development and implementation of auditing and monitoring mechanisms and corresponding corrective actions.
2. Conduct focused internal compliance audits and monitoring, analyze results and provide recommendations to address and resolve issues to promote compliance with the Medicare Advantage and WV Medicaid programs as well as regulatory authorities.
3. Conduct audits which focus on, but are not limited to, such disciplines as marketing, enrollment, claims, appeals/grievances, provider relations and customer service.
4. Must work collaboratively with various departments to detect, track and report program compliance issues
5. Project management as assigned by the Compliance Manager including the production of deliverables within established timeframes.
6. Specialize in one or more areas of compliance (e.g., Medicare, Medicaid, Program Audit, Part D, HIPAA) as assigned by the Compliance Manager.
7. Complete ad hoc assignments as necessary.
8. Participates in external audits (e.g., Compliance Program Effectiveness, Network Adequacy, CMS Program Audits, Timeliness Monitoring Project, Data Validation, Medicaid, etc.) as assigned by the Compliance Manager and/or Government Compliance Officer.