Resp & Qualifications
PURPOSE:
Senior Medicare/Medicaid Auditor will assess organizations operational, financial, regulatory and compliance controls to ensure processes and applications function efficiently and remain in compliance with policies, procedures, and regulations. Evaluates internal operational, financial, regulatory and compliance processes to identify controls and potential risks. Report audit findings to management and recommend solutions to improve operational effectiveness and efficiencies.
ESSENTIAL FUNCTIONS:
- Conduct and or lead Medicaid and Medicare operational, financial, regulatory and compliance audits utilizing computer assisted audit techniques. Analyze and evaluate opportunities for improvement in processes and outcomes and provide audit advice relating to operations; controls; segregation of duties; business process improvement; and related system applications. Participate in the development of the risk assessment for the business process or project under review. Perform process walkthroughs, facilitate Entrance and Exit meetings.
- Responsible for drafting audit findings and draft reports. Maintain audit documentation in automated workpaper repository of business processes and related risks and controls.
- Perform special reviews and audits or advisory services as requested by management. Write reports or memoranda to management communicating the results of the work performed, recommend management action plans, and perform follow-up to validate completion of action plans. Support department strategic initiatives and other special assignments aimed at continuous quality improvement. Advise and consult on risk management and controls for new processes associated with the assigned audits, as appropriate.
- Work collaboratively with the business area to identify and develop recommendations for corrective actions. Write memoranda and status reports to management communicating the risks and recommended corrective action plans identified in these monitoring and advisory activities. Follow-up with business area management to resolve issues identified, including post-audit internal control remediation testing.
- Maintain a repository of operational, financial, regulatory and compliance audit issues and related corrective action plans. Update management on outstanding issues and potential risks periodically. Responsible for ensuring the quarterly issue report is updated timely and provided to management for review based on departmental goals.
- Assist in the coordination of external vendor audit, as well as operational, financial, regulatory and compliances audits as assigned.
QUALIFICATIONS:
Education: Bachelor’s Degree in Business Administration, Management Sciences, Finance, Accounting, or related field OR in lieu of a bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years Progressively responsible auditing, consulting, and business advisory services experience with a project management background.
Preferred Qualifications:
- Possess certification as a CPA, CIA, CFE; advanced degree.
- Medicaid and/or Medicare insurance experience.
Knowledge, Skills and Abilities (KSAs):
- Knowledge of Medicaid, Medicare, state and federal regulatory (e.g., CMS) and compliance guidelines, accounting principles and practices, proficient with data analytic tools (e.g., Excel, ACL) and the analysis and reporting of data.
- Knowledge and understanding of various auditing methods, practices, standards (e.g., IIA, CMS) and automated workpapers (e.g., TeamMate).
- Ability to recognize, analyze, and solve a variety of problems.
- Strong oral and written communication, presentation skills, facilitation skills and business processes.
Department
Department: MAR Compliance Office
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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