Compliance External Audits

Overview

Now hiring a Compliance External Audits!

Presbyterian is seeking a Compliance External Audits that will support the Compliance Manager for External Audits in managing and tracking external audits from clients and regulators or their delegated audit firm. Respond timely and effectively to the external clients and audit agencies as required in the performance of audit response for the Presbyterian Health Plan and Fluent Health. Organize the audit functions and the individual audits. Organize audit deliverables, identify responsible owners, project manage the audits. Work effectively with each of the applicable line-of-business Compliance Managers and the PHP leadership in the audit processes. Escalate issues early in the audit process. Once a final report is issued the External Audit Compliance Analyst will work with the External Audit Compliance Manager in creating applicable remediation plans on any audit findings and observations for management of the applicable remediations through closure.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, Ohio, California, New York, Iowa, and Illinois

Ideal Candidate:

Bachelors degree in health care management, accounting, finance or related field, 6 years of additional experience can be substituted in lieu of degree. 3 years in compliance, healthcare management, auditing or law/regulations.Health care management, accounting, finance or related field.Managed care health plan experience in Medicare or Medicaid or Commercial required.

Qualifications

• Bachelors degree in health care management, accounting, finance or related field, 6 years of additional experience can be substituted in lieu of degree.
• 3 years in compliance, healthcare management, auditing or law/regulations.
• Health care management, accounting, finance or related field.
• Managed care health plan experience in Medicare or Medicaid or Commercial required.
• CHC-Certified in Healthcare Compliance from HCA- Healthcare Compliance Association or SCCE- Society of Corporate Compliance and Ethics or be obtained within 12 months of hire date.
• Desired skills-MS Office skills e.g. Calendar, Word, Excel, PowerPoint. SharePoint, Adobe Pro, PEL, DART, Archer.
• Desired skills-Technical writing, Claims processing applications, Care Coordination systems, Market Prominence, or other enrollment systems.
• Ability to handle multiple projects and deadlines simultaneously.
• Ability to learn new information and skills quickly, use external secure ftp sites, excellent time management skills, critical thinking, analytical skills and problem solving, demonstrates professionalism, communicate effectively.

Education Essential: Bachelor Degree

 

 

Responsibilities

• Project manage and plan and execute external audits from beginning to the end.
• Assess potential risks and controls.
• Discuss audit findings and work on special projects.
• Organize audit deliverables, identify responsible owners, set up audit kick-off meetings, internal and external.
• Set up the data gathering sites for associated audit inputs, audit submission materials, gather and deliver audit materials to the auditors.
• Track, and manage the external audits, utilize the GRC platform to track audit status and submissions, create reporting on audit progress and audit status.
• Direct fieldwork for audit efficiency and inform External Audit Compliance Manager of audit status to manage staff performance
• Coordinate follow-up audits and reviews based on results of prior audit recommendations.
• Gather evidence to support conclusions for higher risk areas according to established department guidelines and industry standards.
• Coordinate with the line-of-business Compliance Managers in evaluating the adequacy of manageme