Mgr, Audit Readiness

Horizon Healthcare Services•Newark, NJ

20h

About The Position

This position manages the execution of the annual Federal Govt initiated regulatory audits and serves as the organizational liaison with CMS for Commercial/GP. This position collaborates with all levels of business partners across the Enterprise to resolve negative audit results which are subject to all levels of corrective action from CMS. The incumbent will lead a team of analysts that will review the findings, which can include civil monetary penalty, discontinuation of Medicare contracts, reject plans for expansion, suspended market activities and warning notices. This position also manages audit readiness across the Enterprise. This is done by hosting “mock’ audits with the business that align with published audit protocols.

Requirements

High School Diploma/GED required.
Requires a minimum of five (5) years of relevant experience, preferably in Medicare Commercial Compliance, and Monitoring/ audit readiness.
Health insurance industry knowledge; including Medicare, Medicaid, or Commercial health plan requirements.
Organization and management of multiple priorities
Analytical
Strong written and verbal communication skills
Attention to detail.
Problem solving
Leadership

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree.
Experience managing teams or leading project work/initiatives preferred.
Prefers federal government audit knowledge.
Prefers analytics experience.
Prefer experience with CMS Program Audit, CMS Compliance Reviews, or Market Conduct Exams.

Responsibilities

Functions as the Organizational liaison with federal auditors, and ensures organizational deliverables are aligned with CMS expectations.
Compiles business responses, universe data, hosts audit sessions, secures executive agreements and signs off.
Initiates corrective actions based on findings, provides guidance to business stakeholders regarding the audit protocols and expectations and will manage the compliance regulatory staff performance.
Manages and updates the CMS audit playbook to ensure readiness appropriate key stakeholders and day 1 through end of audit step by step expectations, as well as manages “mock program audit” reviews quarterly with the business owner
Develops the Annual Audit Readiness Plan in collaboration with the Director, Commercial/GP Compliance, and VP, Regulatory Compliance, as well as prepares and disseminates Annual Audit Readiness results with the Director, Commercial/GP and VP, Regulatory Compliance.
Disseminates the CMS Audits and Compliance Audit Readiness Plan to the affected business stakeholders and provides guidance related to same.
Manages the CMS Audits and Annual Audit Readiness Plan in collaboration with the Director, Commercial/GP Compliance and VP, Regulatory Compliance.
Prepares reports on the Braven Compliance Oversight Committee and or board reports.
Partners with the Director, Commercial/GP Compliance and VP, Regulatory Compliance on Mock Audits for oversight activities.
Collaborate with Regulatory Audit and Internal Audit to ensure alignment with regulatory requirements.