Compliance Audit Specialist (45220)

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 60,000 - 90,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a Compliance Audit Specialist to participate in audits of internal departments and first-tier entities, evaluating controls and identifying gaps. You will create audit reports summarizing findings and corrective actions under the Manager of Compliance Audit.

The role requires a Bachelor’s degree and 2+ years in compliance, with knowledge of Medicare/Medicaid regulatory requirements and experience in auditing.

Qualifications

• Bachelor degree with emphasis in business, health administration or equivalent education and relevant work experience.
• Minimum of two or more years in the field of compliance.
• Knowledge of regulatory requirements related to Medicare/Medicaid programs.
• Ability to understand and implement health care regulations for managed care compliance.
• Experience with auditing, monitoring, and quality assurance.
• Strong business report writing skills and ability to document findings.

Responsibilities

• Participate in compliance audits to evaluate controls and adherence with applicable regulatory and contractual requirements.
• Identify and classify gaps as findings and observations; determine corrective actions.
• Review and assess policies, procedures, and samples for regulatory compliance.
• Track the status of audits and related deliverables.
• Assist the Manager in developing audit reports and annual audit plan.
• Help develop standard audit methodology and best practices.
• Perform other duties as assigned.

Skills

Bachelor's degree

2+ years compliance

Regulatory knowledge (Medicare/Medcaid

Healthcare regulations

Auditing/QA

Strong writing

Record keeping

MS Office proficiency

Independent work

Education

Bachelor's degree in business, health administration or equivalent

Tools

Microsoft Office

Job description

Job Details: Job Location: Smithfield, RI - Smithfield, RI 02917, Position Type: Full Time, Education Level: Bachelors Degree, Travel Percentage: Occasional, Job Shift: Daytime, Job Category: Professional / Experienced, 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 Responsibilities

Responsibilities 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.

Qualifications:

Required:

• Bachelor degree with emphasis in business, health administration or equivalent education and relevant work experience to equate to a degree
• Minimum of two (2)+ 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.
• Demonstrate effective general writing skills 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 (Project, Word, Excel, PowerPoint, Outlook)
• Ability to work independently in a flexible environment

Preferred:

• 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 (2) to five (5) years of relevant experience in the area of Medicare requirements

Neighborhood 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.