Sr Auditor- AHA at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

   Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

  At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

     The job of the Senior Auditor entails various functions in ensuring the success of an organization’s AHA audit programs.

BPO Partnership Performance Management:

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  • BPO external audits:
    
    
    • Prepare external audit supporting documentation
    
    
    • Identify potential issues identified through audits and assist with the implementation of action plans for process improvement based on root cause analysis.
    
    
    • Maintain proficiency in audit standards, policies, and procedures as well as product and system changes pertaining to enrollment, benefits, clinical coding, claims adjudication and customer service.
    
    
    • Determine audit methodology, extent, and scope of testing to be conducted, audit tools, reporting output and appropriate communication mechanisms for all audits
    
    
    • Draft audit findings, management responses, executive summaries, and comprehensive audit reports
    
    
    • Develop effective communication protocols to communicate the results of audits to internal and external stakeholders
    
    
    
    
  
  
  • BPO SLA, MTM and LDLA programs
    
    
    
    • Monitor and report results of SLA, MTM, and LDLA metrics
    
    
    • Evaluate potential findings to determine if findings are reportable
    
    
    • Provide guidance and expertise on BPO client metrics to key internal and external stakeholders
    
    
    • Identify root cause and corrective action, racking errors through implementation of action plan
    
    
    
    
  
  
  
  


• IA MTM Program Audits
  
  
  
  • Maintain AHA's operational performance standards, business rules and audit protocols specific to the BlueCard Member Touch Point (MTM)
  
  
  • Evaluate potential audit findings, making a final determination
  
  
  • For audit errors, identify root cause and corrective action, tracking errors through implementation of action plan
  
  
  • Report program audit results to internal stakeholders
  
  
  • Provide dashboards to internal stakeholders to assist in monitoring performance  
  
  
  • Draft and maintain written audit policies, procedures, scope considerations and statistical sampling methodology
  
  
  
  


• SOC 1 Audit
  
  
  
  • Perform SOC 1 oversight and coordination functions to include:
    
    
    
    • Quarterly monitoring and auditing activities in conjunction with business stakeholders
    
    
    • Coordination with the external auditors and business stakeholders on the engagement testing and evaluation of key controls defined in the SOC 1 reports including obtaining request list documentation   
    
    
    • Drafting SOC 1 reports, compiling report updates received by business management and proofing final versions of the reports prior to issuance
    
    
    • Partnering with business stakeholders to identify and document process and control changes that affect the reports
    
    
    • Consulting with business areas to address any SOC exceptions 
    
    
    
    
  
  
  
  


• Perform all other duties as assigned.

Qualifications:

• Working knowledge of BCBSA MTM, IPP, and LDLA Programs preferred


• Undergraduate degree in business or accounting with a minimum 5 years related audit experience. In the absence of an undergraduate degree, a minimum 7 years related practical experience is required.


• Working knowledge of healthcare operations, auditing and quality assessment programs that include benefits, clinical coding, claims adjudication, enrollment, customer service and related operational processes and systems.


• Strong analytical ability to identify data populations, use random sampling techniques, establish facts, and employ mathematical concepts to draw conclusions from data.


• Ability to interpret an extensive variety of technical instructions, complex data with abstract and concrete variables.


• Ability to document audit findings and to draft executive summaries and comprehensive audit reports.


• Ability to handle a wide variety of complex tasks with competing priorities


• Proven ability to adhere to work plans and schedules, coordinate projects, facilitate meetings and communicate with all levels of associates across the organization.


• Demonstrated ability with Word and Excel required; experience with Power Point preferred.


• Excellent interpersonal, organizational, presentation and communication skills. 


• Strong teamwork and collaboration skills.


• Knowledge of Third-Party Administration experience is a plus.

Hybrid of Choice:

Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

Independence Blue Cross is committed to the health, safety, and well-being of our associates. In support of that focus, Independence expects all new hires to be up to date with COVID-19 vaccination and booster*. Independence’s policy provides reasonable accommodations for medical or religious reasons as required by law. The process for requesting a reasonable accommodation is communicated to candidates when they are offered employment.

* To be considered “up to date” with COVID-19 vaccination and booster, individuals must have received an initial series of the vaccine (whether a 1-dose or 2-dose series) and timely receive a booster once eligible.  Individuals not yet eligible to receive a booster shot will be required to timely obtain a booster once eligible.