Compliance Audit Specialist

Neighborhood Health Plan of Rhode Island • Smithfield, RI

8d • Onsite

About The Position

Under the direction of the Manager of Compliance Audit, the Compliance Audit Specialist participates in compliance-related audits of Neighborhood’s internal departments, functions, processes, and first-tier entities. The Specialist evaluates controls and identifies gaps in adherence to applicable regulatory and contractual requirements. The role also creates audit reports summarizing findings, observations, and necessary corrective actions.

Requirements

• Bachelor’s degree with an emphasis in business or health administration, or equivalent education and relevant work experience to equate to a degree.
• At least two years of experience in the field of compliance.
• Knowledge of regulatory requirements related to the Medicare and/or Medicaid programs.
• Ability to understand and implement health care regulations related to managed care compliance and delegation oversight activities.
• Experience with auditing, monitoring, and/or quality assurance.
• Effective general writing and business report writing skills.
• Ability to establish, nurture, and maintain strong and effective working relationships internally and externally.
• Ability to maintain detailed and accurate records.
• Intermediate to advanced skills in Microsoft Office, including Project, Word, Excel, PowerPoint, and Outlook.
• Ability to work independently in a flexible environment.

Nice To Haves

• Experience in federal and/or state regulatory compliance and/or audit.
• Experience in one or more of the following: healthcare operations, compliance, auditing, investigations, regulatory accreditations, process improvement, project management, and/or managed care operations.
• Two to five years of relevant experience in Medicare requirements.

Responsibilities

• Participate in compliance audits to evaluate controls and adherence to applicable regulatory and contractual requirements.
• Under the direction of the Manager, identify and classify gaps as findings and observations, and determine necessary corrective actions.
• Review and assess policies, procedures, and transaction samples for compliance with applicable regulatory and contractual requirements.
• Track the status of audits and related deliverables.
• Assist the Manager in developing audit reports.
• Assist the Manager in developing an annual audit plan.
• Assist the Manager in developing a standard audit methodology.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level