Senior Regulatory Auditor - Health Alliance Plan - Troy

EDUCATION/EXPERIENCE REQUIRED:  

• Bachelor’s degree in Business Administration, Health Administration, Public Health/Public Policy, Public Planning, Law or other degree with relevant work experience in the healthcare industry. Related and relevant experience or a demonstrated ability to perform the duties of the position may be considered in lieu of academic requirements. Related experience is defined as six (6) years of related experience in healthcare, auditing, managed care or compliance. 
• Two years (2) experience in either internal or compliance auditing for health care institutions or health insurance company. In lieu of internal audit experience, 3-5 years of experience in an operational area and active leadership in CMS regulatory audits such an MAPD CMS Program, Financial or Data Validation Audits, Medicaid Program Integrity Audits or MMP Demonstration Program Audits that demonstrates understanding of the regulations of government programs may be considered. 
• Knowledge of managed care program policies, procedures, regulations, and laws.
• Skill in collecting and analyzing complex data, evaluating information and systems, and drawing logical conclusions. 
• Considerable skill in using a computer with word processing, spreadsheet, process mapping and other business software to prepare analyses, reports, memos and summaries. 
• Considerable skill in effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations. 
• Ability to establish and maintain harmonious working relationships with coworkers, staff and management, and to work effectively in a professional team environment. 

EDUCATION/EXPERIENCE PREFERRED: 

• Master’s or Juris Doctorate degree preferred. 
• Certification as a CIA, AHIA, CHC or CPMA preferred 
• Prior work in health plan claims processing, Medicare Part D, appeals and grievances or Medicare enrollment is a plus.