Resp & Qualifications
PURPOSE:
The External Audit Analyst plans, organizes and manages CareFirst external audit activities (group customer audits, regulatory market conduct examinations, investigations, surveys and inquiries).
ESSENTIAL FUNCTIONS:
- Plan, organize and manage external audit projects of varying complexity and length. Concurrently oversee, coordinate and schedule multiple external audits or examinations to be conducted by auditors representing CareFirst groups or regulatory examiners. Act as the liaison between the external auditors and CareFirst operational areas. Initiate or maintain schedule for projects and project milestones. Track deliverables to facilitate timely completion of external audits.
- Define problems, collect and review data, establish facts, draw valid conclusions and make thoughtful recommendations. Use analytical and problem resolution skills and apply Continuous Quality Improvement principles to system, departmental, data and other relevant issues impacting audit and reporting requirements or performance.
- Communicate in clear and concise manner, prepare cohesive and comprehensive written memos, emails and audit report responses documenting observations and CareFirst position, scope, objectives, procedures, findings, recommendations, comparisons, impacts, risks and projections, often under strict timelines.
- Assist company operational teams and company management in addressing and resolving issues arising from external audits. Make recommendations for appropriate actions and follow-up reviews related to audit findings to ensure that the Company has successfully and consistently implemented corrective actions and performance tracking.
- Review audit rights, performance guarantees and other clauses that affect audit performance standards and perform thought leadership on impact on CareFirst. Understand the business environment and relate extensive knowledge of internal and external activities to trends identified within external audits. Act as a team leader for small projects or work groups through utilizing the ability to begin with a concept and develop or act upon it. May assist with special projects as requested.
QUALIFICATIONS:
Education Level: Bachelor's Degree or in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years of audit experience, in operational or compliance audits, with 3 of those years in health care administration, claims, customer service, health policy or a related field.
Knowledge, Skills and Abilities (KSAs)
- Proficient in quality audit processes and reporting requirements.
- Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint).
- Extensive analytical and problem solving skillsExtensive analytical and problem solving skills.
- Demonstrated skills conducting problem-solving discussions to negotiate effective solutions to audit issues.
- Knowledge of all claims, service and enrollment processing systems.
- Excellent communication skills (verbal and written) with the ability to influence and effectively communicate with all levels of associates and management.
- Good working knowledge of mainframe programs.
Department
Department: Director, External Audit
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
#LI-CB1
|
