Overview:
Program Integrity Audit Supervisor - REMOTE
The Program Integrity Audit Supervisor will primarily be responsible for performance audits of Medicaid Managed Care Plans to identify potential fraud, waste and abuse; issue findings and recommendations; and identify improper payments.
In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse.
This position will report directly to the Program Integrity Project Manager and will work in our Grove City, OH office. If not local, remotely from a home office.
Responsibilities/ Requirements:
Responsibilities:
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Understanding of state Medicaid programs and managed care plan delivery systems
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Planning, coordinating, and conducting performance audits in accordance with Government Auditing Standards
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Understanding managed care encounter data and determining areas that require improved program integrity oversight
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Designing and implementing audit strategies for performing provider payment reviews and managed care plan performance audits, using independent judgment to formulate a plan of action and direction in complex audit scenarios
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Work with auditors to develop audit plans clearly defining scope, steps, and tasks to achieve stated audit objectives including plans of action for audit development and information request processing
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Documenting specific findings and recommendations for improved contract compliance and process improvement; and identifying any improper payments with conclusions based on rule, policy, and billing instructions
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Developing and supporting findings that accurately report condition, criteria, cause, and effect and proposes viable recommendations for corrective actions, as applicable
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Prioritization and assignment of workload, ensuring adherence to task order policies and procedures
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Ensure audit team meets quality and production standards
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Assist in preparing factual and objective written reports in conformance with professional auditing and evaluation standards
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Ensure findings are well defined and are fully supportable, and required reports are submitted according to pre-established time guidelines
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Interpret and apply pertinent laws, regulations, policies, and procedures relevant to the specific audit findings
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Help establish and maintain relationships within UPIC MW as well as outside stakeholders (i.e., state Medicaid agencies, audit clients, law enforcement agencies, CMS, etc.)
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Work closely with the UPIC MW Data Team to understand data analysis projects and their applicability to audits
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Work closely with the UPIC MW Medical Review Team to understand their findings and their applicability to audits
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Ensure departmental compliance with Quality Management System and ISO requirements
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Hire and manage PI staff, responsible for the timely completion of annual employee performance assessments and, when necessary, employee counseling
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Conduct matrix review meetings with auditors to ensure thorough and timely completion of assigned audit tasks in accordance with task order guidelines and direction from CMS
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Participating in presenting findings and justifying recommendations in meetings or conferences
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Perform other duties as assigned by the PI Manager, Deputy PI Manager, PI Project Manager or Medicaid Operations Lead that contribute to task order goals and objectives
Requirements:
- Excellent auditing and leadership skills
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Excellent research and organization skills, prioritization, and time management skills
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Excellent written and verbal communication skills
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Ability to work independently and with minimal supervision
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Ability to multi-task in a fast-paced environment
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Knowledge of auditing principles, statistics, data analysis techniques, and PC skills are preferred
Educational/Experience Qualifications:
- Bachelor’s Degree or equivalent related experience
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Candidates with Certified Fraud Examiner (CFE) Certification will be given priority consideration
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Minimum of two (2) years of experience conducting performance or compliance audits, with preference given to those who have conducted audits involving state Medicaid programs, or one (1) year of experience with an advanced degree
Benefits:
- Medical, Dental, Vision plans
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Life, LTD and STD paid by the employer
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401(k) with company match up to 4%
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Paid Time Off and company paid holidays
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Tuition assistance after 1 year of service
The salary range for this role is $70,000 to $80,000 annually. This is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, geographic location, performance, and business or organizational needs.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
About Us:
CoventBridge is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, caste, disability, veteran status, and other legally protected characteristics.
CoventBridge is committed to the full inclusion of all qualified individuals. As part of this commitment, CoventBridge will ensure that persons with disabilities are provided reasonable accommodations. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact: Human Resources; 888-932-7364; humanresources@coventbridge.com).
UPIC