Responsibilities:

• Design and implement key metrics.
• Drive internal audit initiatives, special projects, and improvement initiatives.
• Evaluate the adequacy, effectiveness and efficiency of the systems of internal control of ongoing operations
• Perform detailed review of work files.
• Review audit responses and action plans developed by the auditee/management.
• Conduct periodic audit follow-up reviews to assess and report on progress or completion of management’s corrective actions.
• Conduct other audit and compliance activity, such as internal investigations, as assigned.
• Prepare internal audit and consulting reports for completed engagements for Director of Internal Audit review.
• Implement and promote internal audit policies and standards.
• Define and implement audit methodology procedures, tools, etc.
• Align audit activities with internal audit strategy, goals, and objectives.
• Design and review audit work programs, testing strategies, and detailed testing procedures.
• Assist in defining and managing content for the internal audit manual.
• Develop and review engagement scope and objectives.
• Contribute to the development of the internal audit training program; work with supervisor to establish training goals.
• Actively participate in all phases of risk assessment and annual audit planning and execution.
• Assist in the annual system-wide Enterprise Risk Management risk assessment cycle
• Provide first level of review on audit issue and report write-ups completed by internal audit staff.
• Provide mentoring and coaching to internal auditor staff and compliance auditors (analysts).
• Effectively communicate with internal audit staff, Director of Internal audit, and management.
• Build relationships with key constituents and serve as a resource of professional advice, as appropriate.
• Build and nurture key management and business relationships
• Manage external relationships – external auditors, regulators and consultants.
• Communicate the results of audit activities via written reports and oral presentations to auditee management when needed, to other specified stakeholders.

Requirements:

• Bachelor’s degree and (7) years’ auditing experience, or experience related to the field, including three (3) years in managed care or government in a compliance or audit capacity; or Master’s plus a minimum of five (5) years’ auditing experience, or experience related to the field, including three (3) years in managed care or government in a compliance or audit capacity.
• Knowledge in auditing standards, compliance standards, enterprise risk management, and audit best practices.
• Knowledge of state and federal Medicaid laws, administrative rules, state policies, and other guidelines.
• General understanding of all major MCO functions. Particularly as they relate to claims processing, utilization reviews, grievance management, provider credentialing, and contracting.
• Ability to interpret contractual agreements and other business documents.
• Ability to maintain confidentiality and handle highly sensitive information with discretion.
• Ability to evaluate financial documents for accuracy, completeness, and compliance.
• Ability to communicate professionally and succinctly with various stakeholders.
• Excellent analytical, decision-making, and time management skills.
• Ability to analyze financial data and identify concerning trends, patterns, and other risks.
• Knowledge of investigative techniques and methods, such as interviewing, gathering evidence, etc.
• Ability to maintain professional competencies related to the internal audit profession, internal control issues, and other relevant topics.
• One of the following professional certifications is required:

• Certified Internal Auditor (CIA)
  • Certified Public Accountant (CPA)
  • Certified Fraud Examiner (CFE)
  • Certified in Healthcare Compliance (CHC)
  • Accredited Healthcare Fraud Investigator (AHFI)
  • Certification in Risk Management Assurance (CRMA)
  • Certified Information Systems Auditor (CISA)
  • Certified Financial Analyst (CFA)
  • Certified Management Accountant (CMA)
  • Certified Financial Services Auditor (CFSA)