AmeriHealth Mercy Family of Companies - Philadelphia, PA

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The Auditor position is responsible for planning and executing independent, objective internal compliance audits designed to test and confirm compliance with applicable State and Federal laws, URAC, NCQA, and SSAE-16 standards or control objectives.

The incumbent will also serve as a subject matter expert within the Company regarding standard monitoring and auditing procedures and best practices

The primary purpose of the job is to :
  • Plans and executes independent, objective internal audits designed to test and confirm compliance with applicable State and Federal laws, URAC/ NCQA UM13 accreditation standards, and internal policies and procedures.
  • Coordinates and performs audit procedures; creates work products such as audit analysis; prepares audit plan and final report summary.
  • Analyzes, understands regulatory and accreditation requirements, and applies identified requirements to business operations when developing and conducting compliance audits.
  • Selects appropriate new laws and regulations and Company policies and procedures to audit against based on risk analysis.
  • Supports the fulfillment of external audits as required.
  • Leads meetings and presents finding and recommendations to management during and at the conclusion of audits. Prepares Corrective Active Plans and monitors progress.
  • Reports audit reports and outcomes to the Compliance and Quality Committees
  • Provides training and presentations to internal departments and PerformRx customers on an as needed basis.
  • Performs other job related duties and projects as assigned.
  • Adheres to PerformRx and AmeriHealth Caritas policies and procedures.
  • Supports and carries out the Caritas Mission & Values.

Position Qualifications/Requirements:
  • Bachelor's Degree
  • One to three years experience auditing

  • Knowledge of standard audit practices
  • Detail oriented
  • Excellent written and verbal communication
  • Ability to analyze, develop, evaluate, write and present work product
  • Experience with presenting and or training
  • Proficiency in MS Word and Excel
  • Experience or exposure to data mining concepts

AmeriHealth Caritas - 15 months ago - save job - block
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