Manager, Government Audit

Palmetto GBA; South Carolina; Remote; USD 83,000 - 165,000; Full time

Job summary

Join a leading insurance company with deep roots in the South Carolina community, where you can contribute to impactful audits in a supportive environment. This role offers the chance to lead a dynamic audit team, ensuring compliance and quality in healthcare operations. With a commitment to diversity and inclusion, the company provides a range of benefits and opportunities for professional growth. If you're ready to make a difference and thrive in a collaborative setting, this position is perfect for you.

Benefits

Health insurance

Dental insurance

Vision insurance

401k

Life insurance

PTO

On-site amenities

Education assistance

Employee discounts

Qualifications

• 5 years of operational audit experience in healthcare.
• 2 years supervisory audit experience or military equivalent.

Responsibilities

• Manage audit workflows and report results to management.
• Respond to provider inquiries and resolve disputes.
• Ensure audit quality and compliance through reviews.

Skills

Operational audit experience

Interpersonal skills

Communication skills

Organizational skills

Decision-making skills

Education

Bachelor’s degree in a related field

Tools

Microsoft Office

Excel

Job description

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Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and a leading administrator of government contracts. We operate a sophisticated data processing center in the Southeast and have a diverse family of subsidiaries, allowing us to leverage various business strengths. We are committed to delivering outstanding service to our customers. If you share this philosophy, consider joining our team!

Position Purpose

Responsible for organizing the audit team to meet departmental, corporate, and CMS expectations, ensuring workload goals are met, and policies are developed and communicated effectively.

Description

Logistics: Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina.

Location: This full-time position (40 hours/week) is remote within the U.S. or onsite in Columbia, SC. Typical hours are 8:00 AM-5:00 PM, Monday-Friday, with possible overtime based on business needs.

What You’ll Do

• Manage audit workflows to ensure timely production and report results to management.
• Respond to provider inquiries on audit topics and resolve disputes.
• Prepare instructions to help staff understand Medicare regulations and company policies.
• Assist in developing QMS instructions and maintain ISO certification.
• Communicate with CMS and other agencies regarding inquiries and audits.
• Evaluate staff performance, conduct interviews, hire, review, and shift staff as needed.
• Ensure audit quality and compliance through reviews and respond to external audit findings.
• Perform special projects and expand technical skills.

Qualifications

• Bachelor’s degree in a related field.
• 5 years of operational/functional audit experience in healthcare.
• 2 years supervisory audit experience or military equivalent (E4 or above).
• Proficiency in Microsoft Office.
• Strong interpersonal, communication, organizational, and decision-making skills.
• Knowledge of accounting, auditing standards, and healthcare systems.

Preferred

• Experience with Medicare cost reports, HFS, HIGLAS, STAR systems.
• Certifications like CIA, CPA, or CISA.
• Strong Excel skills.

Benefits

Eligible after 28 days, including health, dental, vision, 401k, life insurance, PTO, on-site amenities, education assistance, and discounts.

Our Commitment

We value diversity and inclusion, providing opportunities for all employees to develop and contribute.

Next Steps

Application review, possible phone or email screening, followed by interviews with top candidates.

Pay Range

Minimum: $83,057; Midpoint: $123,554; Maximum: $164,051.

Pay decisions depend on experience, location, and internal factors. We participate in E-Verify, comply with pay transparency laws, and are an Equal Opportunity Employer. For accommodations, contact [e-mail] or call 1-800-288-2227, ext. 47480.

Additional Details

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Legal