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MetroPlusHealth · 1 week ago

Senior Manager of External Audits

New York, NY

Full-time

Onsite

Senior Level

$125K/yr - $140K/yr

5+ years exp

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. The Senior Manager of External Audits is responsible for overseeing external audits and supporting the Compliance Program, leading audit engagements, analyzing data, and preparing responses for regulatory agencies.

Financial ServicesHealth CareHealth InsuranceInsuranceLife Insurance

Responsibilities

Lead and execute external audits from regulatory agencies such as NYS Office of State Comptroller (OSC), New York State Office of Medicaid Inspector General (OMIG), Centers for Medicare and Medicaid Services (CMS), New York State Department of Health (DOH), New York State Department of Financial Services (DFS), etc

Proactively engage with internal business areas and vendors to gather evidence, clarify processes and drive a timely response

Analyze datasets received from regulators to assist business areas and/or vendors with their reviews

Streamlines workflow to ensure timeliness and accuracy of compilation processes

Prepare and review audit deliverables, response/dispute letters, and corrective action plans

Mentor and supervisor the Manager of External Audits; set priorities and ensure consistent quality

Responsible for the development and maintenance of tools and supporting documentation related to the external auditing process

Provides primary support during full operational audits

Communicates audit findings and actions required through various reporting mechanisms

Upon identification of non-compliance, provides support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review

Plays a critical role in driving the progress for corrective actions throughout the organization

Refers compliance matters, when necessary, to the appropriate Compliance teams to ensure proper investigation of issues

Other activities as assigned by the Senior Director of Corporate Compliance

Qualification

Healthcare Compliance CertificationManaged Care ExperienceAdvanced Excel SkillsData AnalysisProject ManagementStakeholder ManagementRegulatory KnowledgeWritten CommunicationOral CommunicationInterpersonal Skills

Required

Bachelor's degree from an accredited institution

5-7 years of experience in managed care organization compliance/auditing or healthcare compliance

Experience with managed care, Medicare and federal and/or state regulations and quality improvement

Ability to function independently with limited direction

Advanced Excel skills; experience manipulating large data sets and pivot tables

In depth knowledge of health care policy environments or policy related roles with demonstrated knowledge of leading and supporting cross-departmental employee stakeholders

Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills

Excellent written English; able to produce polished, defensible responses

Excellent oral communication skills, with ability to convey complex information in an accessible way as well as prepare and give presentations to diverse audiences

Demonstrated ability to manage multiple projects, including managing departmental workload in line with the organizational strategy, successfully managing working groups, and proven project management skills

Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team

Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools

The ability to comprehend and interpret regulatory, legislative, and contractual mandates

High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously, manage multiple projects

The utmost integrity in the discreet and confidential handling of confidential materials is necessary