Compliance Audit Specialist

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 75,000 - 110,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a Compliance Audit Specialist to participate in audits of internal departments, evaluate controls, and identify gaps requiring corrective actions. Under the Manager of Compliance Audit, you will assist in developing audit reports, annual plans, and standard methodologies to strengthen regulatory adherence.

This role requires knowledge of Medicare/Medicaid regulations, auditing or QA experience, and strong writing skills.

Qualifications

• Bachelor degree in business, health administration or equivalent.
• Minimum 2+ years of experience in the field of compliance.
• Knowledge of Medicare/Medicaid regulatory requirements.
• Experience with auditing, monitoring or quality assurance.
• Strong writing and business report writing skills.

Responsibilities

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

Skills

Writing skills

Business report writing

Analytical thinking

Auditing experience

Independent work

Education

Bachelor degree in business or health administration or equivalent

Tools

Microsoft Office (Word, Excel, PowerPoint, Project, Outlook)

Job description

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. Through the audits, the Specialist will evaluate controls and identify gaps in adherence with applicable regulatory and contractual requirements. The Specialist will create audit reports to summarize findings, observations, and necessary corrective actions.Duties and ResponsibilitiesResponsibilities include, but are not limited to the following:Participate in compliance audits to evaluate controls and adherence with applicable regulatory and contractual requirements.Under the direction of the Manager, identify and classify gaps as findings and observations, and determine corrective actions necessary.Review and assess policies, procedures, and transaction samples to determine compliance with applicable regulatory and contractual requirements.Track the status of audits and related deliverables.Assist the Manager in the development of audit reports.Assist the Manager in the development of an annual audit plan.Assist the Manager in the development of a standard audit methodology.Performs other duties as assigned.QualificationsRequired:Bachelor degree with emphasis in business, health administration or equivalent education and relevant work experience to equate to a degreeMinimum of two (2)+ years of experience in the field of complianceKnowledge of regulatory requirements related to the Medicare and/or Medicaid programsAbility to understand and implement health care regulations related to managed care compliance and delegation oversight activities.Experience with auditing, monitoring, and/or quality assurance.Demonstrate effective general writing skills and business report writing skillsAbility to establish, nurture and maintain strong and effective working relationships internally and externallyAbility to maintain detailed and accurate recordsIntermediate to Advanced skills in Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)Ability to work independently in a flexible environmentPreferred:Experience in Federal and/or State regulatory compliance and/or auditExperience in one or more of the following: healthcare operations, compliance, auditing, investigations, regulatory accreditations, process improvement, project management and/or managed care operationsTwo (2) to five (5) years of relevant experience in the area of Medicare requirementsNeighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.