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Managed Care Auditor

Company: Accentuate Staffing
Location: Morrisville
Posted on: June 23, 2022

Job Description:

Accentuate Staffing is currently seeking a Managed Care Auditor for an established healthcare provider in the Morrisville area. This is a full time, hybrid, permanent position with great benefits. The Managed Care Auditor completes independent, objective internal audits designed to determine the adequacy of internal controls, and test and confirm compliance with applicable requirements. The ideal candidate must have in-depth understanding of managed car processes and systems. Responsibilities:

  • Design and review audit work programs, testing strategies, and detailed testing procedures.
  • Review audit responses and action plans developed by the auditee/management.
  • Conduct periodic audit follow-up reviews to assess and report on progress or completion of management's corrective action.
  • Review allegations and makes recommendations for audits, investigations, or referrals to other departments.
  • Represent internal audit's goals, objectives, and viewpoints in collaborating with management and business constituents.
  • Track audit and investigation activities in a centralized system from initial assignment to final disposition Requirements:
    • Bachelor's degree in accounting, business administration, a mental health field, or related area from an accredited college or university and at least three (3) years of progressive compliance/regulatory auditing experience, preferably in a healthcare environment.
    • Knowledge of best practice investigative and internal audit protocols, including interviewing, gathering evidence, etc.
    • Knowledge of risk, fraud or health law.
    • Knowledge of state and federal Medicaid laws, administrative rules, state policies, and other guidelines
    • Ability to analyze and understand regulatory requirements, and apply pertinent imperatives to business functions when developing and conducting audits or investigations.
    • Excellent analytical, decision-making, and time management skills.
    • Intermediate computer skills in Microsoft Office (e.g. Word, Excel)
    • Ability to maintain confidentiality and handle highly sensitive information with discretion
    • Ability to evaluate clinical and administrative records for completeness and compliance. Job Requirements:
      • Prepare audit workpapers to support audit findings
      • Improve audit program and audit coverage
      • Assist audit team in developing audit reports
      • Performing an internal compliance audit
      • Facilitate audit activities throughout the audit period
      • Recommend changes in internal audit controls
      • Maintain audit project work papers to support audit findings
      • Maintain audit project work papers to support audit findings
      • Perform audit field work and prepare audit reports
      • Maintain standard review audit maps and audit procedures
      • Training less experienced audit personnel in audit routines and conducting audit reviews
      • Prepare for audit engagements by reviewing prior year audit work papers and audit reports
      • Develop or revise audit procedures for all audit
      • Perform risk based audit planning and develop the audit program for assigned internal audit projects
      • Develop business based audit recommendations and draft audit reports
      • Prepare audit reports and conduct audit briefings upon completion of audits
      • Administer the audit and internal controls
      • Submit conclusions and audit reports for each audit
      • Verify compliance with audit recommendations
      • Train other internal audit staff

Keywords: Accentuate Staffing, Cary , Managed Care Auditor, Other , Morrisville, North Carolina

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