Compliance Audit Specialist (45220)

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.

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.