Client Audit Specialist - Remote

Prime Therapeutics•Home, WV

7d•$66,000 - $106,000•Remote

About The Position

As a member of the Client Audit Management (CAM) team, the Client Audit Specialist is accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is responsible for evaluating and understanding the purpose of various audit types and the related deliverables, developing a holistic understanding of the audit management process, and managing the end-to-end audit activities. This position seeks and obtains additional expertise as indicated from respective Compliance and Operational subject matter experts to meet applicable regulatory, client, and/or functional audit expectations.

Requirements

Bachelor's degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
2 years of relevant work experience in audit, compliance or operations within a regulated environment
Must be eligible to work in the United States without need for work visa or residency sponsorship
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Effective verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings
Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities
Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy
Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
Agility and adaptability to change and navigate in a demanding, dynamic, fast-paced, intense, and matrix environment
Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence
Intermediate to Advanced skills in Microsoft Office Suite (Word, Excel)

Nice To Haves

Health insurance/PBM operations and/or contract audit experience
Experience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefit
Project management experience

Responsibilities

Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request
Present sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implications
Develop and maintain key internal and external stakeholder relationships to effectively provide audit consultation, streamline work activity, create/drive efficiencies, and ensure consistent, timely, and accurate audit completion, reporting, or submission of deliverables
Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to Audit Advisors, department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings
Perform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirements
Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes
Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders
Integrate project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, throughout the entire audit
Support department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained
Other duties as assigned