Job Description

Job Description

Responsibilities

Job Summary:

The Operation Auditor position provides support regarding standard monitoring and auditing procedures and best practices to meet business objectives. Responsible for the design, development, implementation and support of reports and/or extracts. Working with Business Leaders, subject matter experts and vendors to gather and document reporting requirements to meet business needs. Performs reviews of Medicare Appeal to ensure all contractual requirements have been met and all appeal components have been completed accurately. Plans and executes independent, objective internal audits designed to test and confirm compliance with applicable State and Federal laws. Analyzes and understands regulatory requirements, and applies identified requirements to business operations when developing and conducting compliance audits. Coordinates and performs audit procedures; creates work products such as audit analysis; prepares audit plan and final report summary. Monitors the progress, up to the remediation, of all deficiencies once identified. Supports the fulfillment of internal/external audits as required. Performs other job related duties and projects as assigned.

Qualifications

Requirements:

High school or equivalent. Associate degree preferred
3 years health plan operations experience or health services experience with Medicare programs, or specifically relevant experience with compliance requirements for Medicare programs, or other relevant experience such as work in compliance, legal and/or other related positions.
Good organization skills with ability to prioritize multiple activities in a rapidly changing environment
Excellent interpersonal, communication and organizational skills with the ability to interact with all levels of personnel within the organization.
Ability to understand from a systems level perspective the interdependence of one unit or system upon another, and how changes in any one part affect all others.
Demonstrated ability and professional concern for bringing together knowledge of operations and information needs of users.

Language Skills:

Ability to effectively communicate in English, both verbally and in writing.
Skills:

Excellent computer skills.
Self-starter, Resourceful and able to execute projects in a fluid and fast paced environment
Good organization, management, and reporting skills
Attention to detail
Strong knowledge and experience with MS Office, MS Project, MS Visio with the ability to use these and other tools to provide meaningful analytics
Ability to effectively contribute as a team member or on individual assignments.
Must be able to work independently; providing management with status updates
Excellent analytical and problem solving skills.
Strong customer service focus
Knowledge of operational processes within the Health Plan.
Strong negotiation and persuasion skills.
Excellent written and verbal communication skills.
Ability to interact with all levels of personnel.