Helps plan and perform internal audits of Funds and contractor business processes to assess the effectiveness of internal controls, the efficiency and effectiveness of operations and adherence to relevant laws and regulations. Interacts frequently with Funds’ directors and senior executives at contractor organizations.
PRIMARY DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Interviews and performs walkthroughs with employees and contractors to develop a detailed understanding of current workflow processes.
Evaluates the operational effectiveness and efficiency of Funds’ and contractor business processes and determines the adequacy of internal controls and compliance with applicable laws and regulations.
Conducts research into technical topics relating to internal audit matters and the interpretation of legal documents.
Assists in the preparation of internal audit programs and conducts internal audit testing, creating internal audit file workpapers to document the work performed and conclusions reached.
Prepares draft internal audit reports of findings and recommendations for management.
Engages in open communication with the Internal Audit team to ensure timely deliverables and assists in communicating internal audit findings to auditees.
Performs quarterly internal audits on a routine basis for payment accuracy.
Responsible for adhering to all Funds policies and procedures adopted to comply with the Health Insurance Portability and Accountability Act (HIPAA) governing the privacy, security, and use of protected health information.
Exposure to pension and/or medical and drug claim operations is strongly preferred. In addition, familiarity with Sarbanes-Oxley, HIPAA and ERISA is preferred. Requires well-developed analytical skills and their application to a wide range of abstract, intellectual, and practical problems within a changing business environment.
Requires an understanding of management and internal control principles at a sufficient level to recognize and evaluate the materiality and significance of deviations from effective internal controls and good business practices.
Knowledge of medical terminology preferred.
Knowledge of CPT, ICD and HCPCS codes preferred.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Four-year college degree (business degree with Accounting major preferred); plus 2 to 4 years related experience in public accounting or a high-quality internal audit function preferred; and, 2 to 4 years of experience in examining medical claim types desired.
Ability to read, analyze, and interpret complex material such as technical journals, financial reports, internal policy statements and legal documents. Ability to write with precise language to communicate highly complex, abstract or sensitive information. Ability to effectively communicate information to all levels of organization’s management, external auditors, outside agents, contractors, and government agencies.
Requires use of intermediate mathematical formulas and calculations to prepare or interpret routine statistical or financial information.
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
CERTIFICATES, LICENSES, REGISTRATIONS
Certified Public Accountant (CPA) License or Certified Internal Auditor (CIA) is preferred. Must obtain CPA or CIA certification or complete CEU’s to obtain active status within 18 months of hire.
OTHER SKILLS AND ABILITIES
Requires computer skills at an intermediate level to generate word processing letters/reports, basic spreadsheet usage and/or operating printers and other peripheral devices.
The physical demands described here are representative of those that are typically experienced by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; talk or hear. The employee is occasionally required to stand, walk, reach with hands and arms, and climb or balance. Specific vision abilities required by this job include the ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet.
COMPLETE BACKGROUND CHECK REQUIRED
Employee assistance program
Flexible spending account
Paid time off
Professional development assistance