This position is responsible for supporting Advantasure Appeals and Grievances Department by assisting leaders in regulatory and client reporting, audit monitoring, and maintenance of regulatory and client requirements (e.g. Medicare Advantage and Prescription Drug requirements in accordance with CMS, appeals and grievances requirements, etc). Consults with business areas and other subject matter experts to identify compliance/client requirements, assess risks, and recommend compliant solutions that support business goals. This position acts as subject matter expert on applicable reporting regulations and audit protocols (e.g. CMS, Medicare Advantage, etc.), related training and awareness programs, and for responding to applicable compliance-related inquiries (e.g. HPMS reporting, regulatory audits, data validation audits, etc).
Senior Audit Project Consultant RESPONSIBILITIES/TASKS:
- Leads preparation for regulatory reporting and audit activity and A&G-related compliance programs.
- Leads cross functional teams comprised of various internal customers and client resources.
- Lead complex development initiatives. Manages teams and ensure that project resources are utilized in an effective and efficient manner. Ensure project goals are met or exceeded via the facilitation and resolution of barriers prohibiting the progress on projects.
- Plan projects, including the concept, design, planning, project scope, cost and benefits, testing, acceptance, implementation and post-implementation review of project deliverables.
- Recommends and implements process changes to increase project execution performance.
- Leads preparation for regulatory reporting and /or audit activity and A&G-related compliance training programs.
- Partners with, and influences as necessary, subject matter experts.
- Provides assistance and mentors staff on project management related issues.
- Reviews system and tools to ensure quality and efficient implementation of development and enhancement efforts.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.EMPLOYMENT QUALIFICATIONS: EDUCATION OR EQUIVALENT EXPERIENCE:
Bachelor's degree in a related field required. Master's degree in Business Administration and additional related certifications preferred. Relevant combination of education and experience may be considered in lieu of degree. Certification or progress toward certification, such as Compliance Certification Board (CCB), is highly preferred and encouraged.Project Management / Project Management Certificate (PMP) preferred. Senior Audit Project Consultant
7 years in related healthcare field, Medicare Advantage preferred which may include experience in technical/systems, information security, compliance and/or audit. 5 years project management experience in health plan operations or related field required. Leadership/supervisory experience and/or analytical experience with data, systems, and operations. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED
- Ability to develop and present complex materials in a clear, concise and persuasive manner.
- Working knowledge of HIPAA legislation, privacy rules, or security standards, or federal regulations related to Medicare Parts C and D, or advanced knowledge of risk assessment concepts and generally accepted auditing principles.
- Ability to plan, organize, direct and control projects while exercising high ethical standards and good judgment.
- Ability to define analysis needed and complete work when little direction is provided.
- Excellent analytical, organizational, interpersonal, problem solving, written and verbal communication skills, as well and the ability to apply concepts to practical situations.
- Ability to work independently with minimal supervision, within a team environment and handle multiple assignments.
- Working knowledge of PC applications (Word, Excel, PowerPoint and Outlook).
- Other related skills and/or abilities may be required to perform this job.
Knowledge of program management
- Demonstrated proficiency and experience with project management applications, templates, development tools, and analysis tools
- Demonstrated knowledge and experience planning and leading high risk and complex projects
Work is performed in an office setting with no unusual hazards. Field position.
The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.
We are an Equal Opportunity Employer. Diversity is valued, and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.