Leads and performs compliance and performance risk audits to validate whether operational departments are operating in accordance to customer contractual requirements and applicable state and federal laws. Through the use of a routine method of review and data analysis, assists in the prevention, detection, correction, monitoring and auditing of health plan compliance risks. Responsible for assisting operational departments, such as Health Services, with departmental and internal compliance data collection, trending and analysis. Works with the departments being audited and provides any education needed, and advises on best practices.
Leads and performs all aspects of an audit, including planning, testing of controls, data analysis, preparing accurate work papers to properly document findings, outcome education and best practices.
Ensures adequate documentation supports the audit findings and complies with Compliance department standards and guidelines.
Leads and prepares objective, accurate and factual formal and informal audit reports summarizing the results of the audit work performed, determining effect and risk.
Identifies, analyzes and assesses complex enterprise-wide environment, regulatory compliance inquiries and issues, and compliance program needs.
Recommends compliance programming, compliance initiatives and internal departmental controls.
Leads and performs entrance conferences, exit conferences and audit interviews.
Oversees research and applies appropriate Federal, State, and contractually based requirements required to perform specific audits.
Monitors operational metrics and indicators related to compliance performance and coordinates all activities related to non-financial, regulatory audits.
Leads and conducts data based compliance risk assessments and/or audits and monitors operational units for compliance.
Assures appropriate implementation and/or corrective action is taken to address risks and issues identified.
Communicates work product that meets professional, ethical and audit standards for clarity and completeness.
Coordinates compliance data needs for operational departments, to include collection, trending and analysis to identify compliance and areas of risk.
Meets regularly with operational departments to review data analysis and assist in the execution and monitoring of corrective measures.
Leads in developing instructional materials and providing technical assistance related to compliance and performance audit findings.
Assists the Compliance Manager or Officer with developing and publishing compliance and internal control tools and guidance for internal employees and sub-contractors as required by the contract, and any applicable Federal, State and Local rules and regulations.
General Job Information
Senior Compliance Auditor - remote opportunity
United States of America
United States of America (Exempt)
Recruiting Start Date
Date Requisition Created
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
1-3 years of experience in data analysis, compliance auditing, program evaluation, management or policy analysis, or related experience.
3-5 years of experience conducting data analysis, health plan operations, compliance and performance auditing for a health plan.
Demonstrates strong leadership abilities.
Displays teamwork and integrity.
Supports colleagues and values others contributions.
Fosters an efficient, innovative and team-oriented work environment.
Knowledge of Medicare and Medicaid contractual requirements and health plan data analysis and audit processes, internal auditing, healthcare, and operation.
High level of personal and professional integrity.
Significant knowledge of operational processes, efficient and effective workflows, and best practices in a managed care organization.
Familiarity with all phases of an audit including planning, analysis, report writing corrective action plan development, and follow up education.
Ability to work independently and effectively work with team members at all levels.
Excellent research and analytical skills.
Ability to analyze data and draw conclusions.
Ability to manage multiple projects, including establishing deadlines for individual assignments as well as Compliance team deadlines.
Ability to provide constructive feedback via work paper review and formal/informal education.
Must be trusted to keep information confidential.
Strong written, verbal and interpersonal communication skills are required.
Ability to deal with many functional areas of a national organization.
Ability to identify processing/policy issues as they apply to corporate and contract standards.
Strong PC skills required.
Proficient in Microsoft Office Product Suite.
Database management, spreadsheet software and word processing skills.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.