Resp & Qualifications
PURPOSE: The External Audit Analyst plans, organizes and manages CareFirst external audit activities (group customer audits, regulatory market conduct examinations, investigations, surveys and inquiries) conducted by audit firms hired by current or former group customers or conducted by regulatory agencies including the Virginia Bureau of Insurance (VBOI), Maryland Insurance Adminstration (MIA), US Department of Labor (DOL), District of Columbia Department of Insurance, Securities and Banking (DISB), Centers for Medicare and Medicaid Services (CMS), Office of Personnel Management (OPM), and BlueCross BlueShield Association (BCBSA), among others.
PRINCIPAL ACCOUNTABILITIES (Scope % equaling 100%): Under the direction of the Manager and Director, External Audit Coordination, the principle duties and responsibilities include, but are not limited to, the following:
50% Plan, organize and manage external audit projects of varying complexity and length. Concurrently oversee, coordinate and schedule multiple external audits or examinations to be conducted by auditors representing CareFirst groups or regulatory examiners. Act as the liaison between the group customer’s auditor or regulator and CareFirst operational areas. Initiate or maintain schedule for projects and project milestones. Track deliverables by the company to facilitate timely completion of external audits. Coordinate with external agencies and internal departments on documentation requests and submissions, preparing for external audit onsite reviews and corrective action plans.
Define problems, collect data, review the data, establish facts, draw valid conclusions.
Use analytical and problem resolution skills and apply Continuous Quality Improvement principles to system, departmental, data and other relevant issues impacting audit and reporting requirements or performance.
Communicate in clear and concise manner issues, alleged errors and trends found in external audits to Manager or Director, External Audit Coordination. Prepare cohesive and comprehensive written memos, emails and audit report responses documenting observations and CareFirst position, scope, objectives, procedures, findings, recommendations, comparisons, impacts, risks and projections, often under strict timelines.
40% Assists company operational teams and company management in addressing and resolving issues arising from a regulatory or self-insured large group audit. Make recommendations for appropriate actions and follow-up reviews related to group or regulatory audit findings to ensure that the Company has successfully and consistently implemented corrective actions.
5% Review customer's contracts for audit rights, performance guarantees and other clauses that affect audit performance outcomes. Understand the business environment and relate extensive knowledge of internal and external activities to trends identified within an external audit and across numerous external audits.
5% Act as a team leader for small projects or work groups through utilizing the ability to begin with a concept and develop or act upon it. May assist with special projects as requested.
SUPERVISORY RESPONSIBILITY: None
This position is responsive to all audited areas of the CareFirst enterprise. Failure to perform duties could result in CareFirst leadership not being advised of critical potential audit findings that may carry financial liability and the company’s presentation of an insufficient response. Position interacts directly with many levels of associates up to and including Vice President.
Bachelor’s Degree preferably in Health Care Administration, Health Policy or Business Administration, 3 – 5 years of audit experience, in operational or compliance audits, with 3 of those years in health care administration, claims, customer service, health policy or a related field.
Work schedule flexibility is necessary to support the audit and regulatory processes.
Abilities/Skills: Must have solid writing skills including mastery of grammar, punctuation and ability to explain reasonably complex concepts. Demonstrates competence in the areas of critical thinking. Maintain strictest confidentiality, exercise independent judgement and have excellent interpersonal skills. Ability to organize large amounts of data. Ability to write detailed memos and responses to audit issues. Ability to manage multiple priorities in a fast paced environment. Must demonstrate innovation and creativity in problem solving with attention to detail. Must be self-motivated. Ability to deal with all levels of management while working with cross-functional teams. Ability to effectively present information to CareFirst operational teams and audit firms.
Preferred: Experience with any combination of the following audit types preferred: state Market Conduct Examinations, federal regulatory examinations, group claims, financial, licensure, health care quality, or general health care operations. Knowledge of CareFirst organization and operations. Health care claims processing or customer service experience is helpful.
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
The employee is on the move frequently, attending meetings and talking with other individuals regarding certain audits and projects. Ability to travel by public transportation and through driving a car is required to coordinate audits in various CareFirst locations and other sites. Hands will be used to operate a computer, write, type, and handle paper files. Will lift boxes of reports and notebooks. Bending is required in order to sort and compile files.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 10/23/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship