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.
- 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