Description
Responsible for evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to enrollment and billing and claims processing, as well as customer service written and verbal inquiries. Primary duties may include, but are not limited to: Providing training and guidance for audit staff, answering questions from the staff around the audit process or multiple system questions that may arise. Administers audit-the auditor program and provides results and recommendations for corrective actions. Managing audit workload and ensures operating efficiency for the audit process. Ensures the implementation and execution of audits and monitoring adherence to the prescribed audit methodologies and documentation, and completing analysis and trending of audit results. Interacts regularly with business and vendor partners, presenting contractual and audit program results, reviewing discrepancies and validating implementation of action plans, managing appeals processes, identifying process improvement opportunities, and performing calibration sessions for various audit scenarios. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires a BA/BS degree; 5 years of experience including 3 years of progressively responsible audit experience and at least 2 yrs leadership experience of similar capacity; or any combination of education and experience, which would provide an equivalent background. Basic understanding of statistics, thorough understanding of different audit methodologies, in-depth knowledge of multiple systems and proven understanding of processing principles, techniques and guidelines required. Excellent organizational, project management, analytical, leadership, verbal and written communication skills required.
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