The Internal Auditor is responsible for the timely execution of risk-based internal audits in accordance with the annual audit plan, as well as assisting with other audit matters and projects.
Education, Certifications, Licenses and Experience
Requires education and experience equivalent to a Bachelor’s degree in business, accounting, statistics, or a related field, plus 2 years of job-related experience in auditing, accounting and regulatory compliance and reporting. Certified Internal Auditor (CIA) credentials preferred, but not required. Audit experience in a highly regulated environment a plus.
Primary Duties and Responsibilities:
A. Auditing (85%)
Perform audits and/or reviews of various operational functions.
Develop and implement a comprehensive internal audit program that incorporates regular periodic audits of various operational functions.
Maintain and update auditing procedures as regulated by the Compliance Officer, Compliance Committee, and various regulatory agencies.
Maintain a record/database of all auditing functions performed including dates, participants, findings, required follow-up, and all other relevant information.
Document and report audit findings to the Compliance Officer and relevant managers, including recommendations for improved policies and/or procedures.
Provide the Compliance Committee with quarterly updates regarding audits performed and scheduled, relevant findings, areas of concern, etc.
Conduct follow-up reviews of financial, operational, or regulatory compliance deficiencies noted during audits.
Assist in the coordination of regulatory reviews by external parties such as the State Commissioner of Insurance and Securities and the Centers for Medicare and Medicaid Services (CMS).
Conduct risk assessments of assigned departments or functional areas.
Conduct audit testing of specified areas and identify reportable issues and dimension of risk.
Determine compliance with policies and procedures.
Other Duties as Assigned (15%)
Perform a variety of other duties as assigned by the supervisor. This includes coordinating special projects and events, attending training and continuing education and providing backup and coverage for other Compliance staff. Support activities related to Enterprise Risk Management.
The above statements are intended to describe the general nature and level of work being performed by employees in this position. They are not intended to be an exhaustive list of all duties, responsibilities and qualifications of employees assigned to this job.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit. The employee is frequently required to stand, walk, talk and hear including communicating effectively over the phone and in person. The employee may occasionally lift and/or move up to 25 pounds. The noise level in the work environment is usually moderate. Regular and timely attendance during core office hours, Monday through Friday, is an essential requirement of the job.
Knowledge, Skills and Abilities
Advanced knowledge of the health care industry to include health insurance practices
Advanced knowledge of internal and external audit practices
Advanced knowledge of health plan operations
Basic data analytics
Understanding of regulatory practices regarding State and Federal health programs
Knowledge of Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT)-4, International
Classification of Diseases (ICD)-10, and insurance claims
Solid knowledge of risk assessment, control analysis, and audit methodology
Medicare Advantage and Medicare Supplement knowledge desired
Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations, and other guidance
Excellent customer service and interpersonal communication skills (oral and written)
Highly organized with special attention to details and deadlines
Creative problem solving with a focus on teamwork and collaboration
Proficient in Microsoft Office and database software
Read and apply regulatory guidance
Clearly and concisely communicate with all organizational areas
Timely and accurate response to audit related inquiries
Demonstrate appropriate sensitivity, confidentiality, tact, and judgment in complex situations and collaborate effectively throughout the organization
Function independently and within a team working toward common goals
Versatility to manage changing priorities and workflow for multiple projects and deadlines
Commitment to excellence and high standard of integrity, professionalism, and trustworthiness are required