Position
Audit Specialist
Description

The Audit Specialist is responsible for ensuring that RxAdvance and health plan clients maintain all regulatory and compliance standards in regard to audits. The Audit Specialist will work with all departments (client business, technology, and operations) to guarantee that departments are maintaining optimal results.

Responsibilities
  • Assist in the developing, monitoring and auditing of internal business, technology, and operations against internal Policies and Procedures to meet state and federal regulations
  • Interaction with third-party vendors to complete external regulatory audits
  • Identify and track compliance issues based on audit results that require follow-up or investigation
  • Work closely with diverse departments to manage the audit schedule, scope, and quality to meet established agreements
  • Create audit reports for internal usage on a regular or ad-hoc basis to determine the progress of yearly audit plan
  • Other responsibilities as required
  • Have a thorough understanding of, and perform in compliance with, the current PBM v2.2 URAC standards applicable to the position
Qualifications
     

  1. Education and/or Training:
    • Bachelor’s degree required,
    • Degree in public policy or healthcare management fields are preferred
  2. Professional Experience:
    • 1-3 years of experience working in operational roles related to compliance in a health plan or third-party administrator
    • Prior Medicaid/Medicare/Commercial/HIX experience is preferred
  3. Licenses/Certifications:
    • NA
  4. Specialized Skills:
    • Strong verbal and written communication skills to inform and educate internal and external stakeholders on all regulatory rules
    • Ability to work independently with minimal supervision
    • Motivated and detail-oriented
    • Ability to visualize processes and identify core functions
    • Careful attention to detail with strong analytical capabilities
    • Team player with a collaborative working style
    • Ability to multitask on different projects and timelines
    • Strong interest in healthcare and technology industries
  5. Technical Skills:
    • Strong PC skills; MS Word, Excel, Access, and Power Point
  6. Additional Considerations:
    • Applicants must be able to pass a background investigation as all offers are pending a successful completion of background check per the company policy
Physical and Mental Requirements:
  • Some travel may be required

Position: Audit Specialist

Thank you for submitting your application. We will contact you shortly!

Report to
Director of Compliance
Department
Compliance
Job Location
Southborough, MA
Working Hours
Full-Time
Date posted
May 10, 2019