Compliance Auditor Analyst, Medicare

Job Description

The Compliance Auditor/Analyst, Medicare will assist the Director, Medicare Compliance with supporting the Medicare compliance program operations, performing detailed compliance audits focused on the Medicare line of business, assisting on the analysis of compliance program effectiveness, and supporting additional key compliance initiatives, and compliance projects.

• Plans, coordinates and conducts compliance audits in accordance with the approved Medicare audit plan, including internal audits and vendor audits
• Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; identifies compliance risks and recommends opportunities to strengthen the internal control structure
• Completes audit work papers and creates reports to document audit findings
• Maintains excellent documentation of all audits, methodologies employed, results, implementation of recommendations, and monitoring
• Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings
• May assist with identifying and resolving deficiencies
• Reviews, disseminates and tracks HPMS memos
• Reviews and submits marketing material to HPMS
• Assists in the development of Compliance policies and procedures with strong working knowledge of policy development
• Maintains a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting Medicare Managed Care organizations
• Participates in other compliance program elements for the ongoing demonstration of compliance effectiveness
• Collaborates with the Director, Medicare Compliance on external audits and reviews, which are initiated by government agencies or government-contracted organizations
• Assists Director,Medicare Compliance with responding to CMS requests and audits
• Performs other duties as assigned

Qualifications

• Bachelor’s degree preferably in accounting, business or healthcare administration
• 3+ years of compliance audit experience in a healthcare environment; managed care experience preferred
• Must have proven healthcare audit, compliance, payor, regulatory/audit background

• Excellent analytical and critical thinking skills
• Ability to manage multiple projects and adapt to changing priorities
• Strong facilitation, collaboration and interpersonal skills with the ability to build productive cross-functional partnerships to drive business results
• Must be proficient with Microsoft products (Excel, Word, and Power Point)
• Must demonstrate solid technical proficiency, possess strong verbal and written communication skills, and demonstrate an ability to set and meet goals and priorities
• Knowledge of healthcare compliance (i.e. CMS regulations and Medicare Advantage program requirements) and integrity policies required
• Excellent follow-up skills to keep projects and tasks on track
• Detail-oriented with an ability to meet stringent deadlines

Certified in Healthcare Compliance (CHC) preferred

Additional Information

Integra is an Equal Opportunity Employer and prohibits discrimination or harassment based on any characteristics protected by the laws or regulations in the locations where we operate.

If this opportunity sounds exciting and challenging to you, please click “Apply” now!