Compliance Auditor in New York, NY
- Title: Compliance Auditor
- Code: RCI-81300
- Location: New York, NY 10004
- Posted Date: 11/14/2022
- Name:Anthony Blomer
- Email: firstname.lastname@example.org
- Phone: 908-704-8843 ✖
HYBRID - 2-3 days per week in office
The Compliance Auditor will support compliance activities, including conducting audits and ongoing monitoring, overseeing corrective actions and developing related tools to track and report information. The Compliance Auditor will work to ensure that the Corporate Compliance Program provides the effective prevention, detection, and control activities necessary to meet the plan’s regulatory obligations.
- Assist the Compliance Auditing Manager in the development of the annual risk assessment for the business areas affected by the Model Audit Rule and implementation of the department and team’s annual work plans.
- Responsible for developing, tracking, and executing audits based identified risks and areas of focus for our regulators. Auditor is expected to develop audit plans with clearly defined scopes, measures, and timelines.
- Assist in conducting audits of internal controls to support the Model Audit Rule (MAR) as required by NY State. This process closely mirrors audits conducted under the Sarbanes-Oxley Act and ranges from ensuring the continuing completion of routine bank reconciliations to posting the amounts of claims liabilities calculated by external actuaries to assessing the strength of IT controls granting new employees access to the organization's network.
- Conduct research into best practices and identify standards used to select relevant samples in order to validate processes.
- Complete assigned audits and responsibilities within required timeframes by managing time effectively and remaining cognizant of key milestones and potential delays.
- Analyze/review data collected during audits and design/prepare concise reports for review and presentation to management and stakeholders, making recommendations for improvement.
- Upon identification of non-compliance, provide 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 action plans throughout the organization.
- Work with all levels within the organization to ensure that internal controls throughout the system provide for accurate, complete and compliance program and processes.
- Collaborate and coordinate with internal and external auditors to improve alignment of governance, risk, and compliance considerations.
- Participate in special projects, often involving research into and auditing of medical claim transactions for accuracy, consistency, and validation of suspected errors.
- Contributes timely data of good quality for the materials prepared for both the Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
- Assist the department in the use and development of web-based apps used to track completion of compliance projects. This includes monitoring data, storing documentation, extracting information in concise formats, and helping to identify and incorporate suggestions for continuous improvement.
- Propose recommendations directed at strengthening the structure of internal controls and the broader control environment through corrective action plans and remediation activities.
- Monitor successful implementation of those determined to be essential.
- Other duties as assigned or requested.
- A Bachelor’s degree required.
- 3-5 years of Managed Care experience.
- 3-5 years’ experience in a compliance, internal auditing, or finance function within a Managed Care Organization.
- Preferred candidate will have knowledge and experience in the following:
- NY State Model Audit Rule or Sarbanes-Oxley Act
- Finance and accounting processes
- Project/audit management
- Developing reporting and metrics
- Proficient in Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools and Adobe Acrobat.
- Prior successful experience working with regulators on compliance audits, reporting and other matters.
- Demonstrated ability to quickly adapt to changing technology, including direct responsibility for routine maintenance of limited components within systems and software. Previous experience in building low-code apps and/or reports in platforms such as QuickBase a big plus.
- Enhance the reputation of the Compliance department and the overall organization by adhering to productivity, quality, ethical and customer service standards. Accept ownership for responsibilities and add value by resolving operational problems and identifying process improvements.
- Desire to pursue ongoing personal and professional development by updating job skills, behaviors, relationships, and knowledge of regulations affecting healthcare insurers.
- Broad-based in-depth knowledge of the managed care industry, including strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
- Experience with managed care, state and federal regulations, quality improvement and compliance oversight.
- High-level of skill in leading interdepartmental and cross-functional projects; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
- Ability to function independently and manage multiple projects at once under limited direction while building effective interpersonal relationships with coworkers, peers and members.
- Excellent oral, written, and presentation skills, state as well as conceptual and analytic skills are necessary to review and articulate corporate objectives and Federal regulations across all relevant audiences.
- The utmost integrity in the discreet and confidential handling of confidential materials is necessary.
- Proficiency in quickly grasping and readily adopting new software apps. A knack for spotting opportunities to streamline operations through automated fixes aimed at enhancing the working experience of teammates and fellow users.
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