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Independence Blue Cross · 4 weeks ago

Senior Audit Analyst

Philadelphia, Pennsylvania

Full-time

Hybrid

Mid, Senior Level

3+ years exp

Independence Blue Cross is focused on renewing and reimagining their business in the healthcare sector. The Senior Audit Analyst will ensure the timely completion of operational and financial external audit projects while addressing audit issues and training new audit analysts.

Health CareHealth InsuranceInsuranceMedical

Responsibilities

Serve in a senior role to ensure the timely completion of operational (and some financial) external audit projects in accordance with agreed-upon audit criteria, sound audit practices, and the IBC Audit Policy

Develop strategies and discuss with management approaches to resolve operational/audit issues

Ensure all assigned deliverables are completed with the written audit expectations for the external audit project

Address all confirmed audit issues identified from an Operational Audit project with the internal IBC stakeholder departments to ensure the root cause has been properly identified, verify the implementation of remediation steps and verify the completion of any financial/claim impacts

Serve as point of contact and knowledge expert for external auditors and internal stakeholder departments

Review all internal responses to potential errors/issues from departments for accuracy and completeness

Evaluate responses and modify as needed to address properly an internal or external audience

Prepare and quality review all audit supporting documentation prior to issuance

Monitor resolution of confirmed manual and systemic issues/errors

Serve as an information resource to Audit and client management regarding audit requirements and processes

Train and develop new audit analysts

Other duties as specified

Qualification

Healthcare operational auditingRoot cause analysisHealthcare claim adjudicationProvider pricing/contractingOral communicationWritten communication

Required

B.S. Degree with 3 or more years of knowledge of healthcare operational auditing or equivalent quality analytical experience of healthcare products

Experienced knowledge in the utilization of operational audit procedures or quality review analysis experience to complete root cause analysis, verify implemented controls and resolutions to confirmed audit findings

General understanding of healthcare claim adjudication, provider pricing/contracting, and account benefit set-up for healthcare products

Working knowledge of medical healthcare benefits/products

Possess strong oral skills for communication with various levels of management and strong written skills for drafting responses to audit findings

Preferred

Working knowledge of pharmacy benefits/products is preferred but not required

Preferred but not required working knowledge of federal regulations regarding Federal Employee Program (FEP)

Preferred but not required working knowledge of the BCBSA Member Touchpoint Measures Program (MTM), BCBSA Line Desk Level Audit (LDLA), Interplan Teleprocessing System (ITS), Health Rules and OSCAR claim adjudication systems is preferred but not required