29 days old

Senior Audit Specialist- White Plains, NY or possible Telecommute (local candidates only)

White Plains, NY 10601 Work Remotely
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With limited oversite from the Supervisor/Manager of Audit, the Senior Audit Specialist is responsible for performing all stages of the external audit process and for monitoring client Utilization Management processes to assess proper compliance with Regulatory, NCQA / URAC Accreditation and client requirements.  The Senior Audit Specialist utilizes all available compliance related information to review for compliance with corrections and conducts monitoring functions as assigned.  This individual plays a key role in compliance issue identification and resolution and suggesting methods for successful issue resolution.  With some guidance, as needed from the Supervisor/Manager of Audit, this role may provide explanations and interpretations within their area of expertise. 

Primary Responsibilities:
External Audits
  • Ensures all required documentation (e.g. manuals, policies, requested files, etc.) requested by the payer health plan are available for review for on-site, remote and webinar audits.
  • Creates Audit case files according to schedules, as applicable.
  • Previews files and materials requested for audits.  Provides supervisor / manager a comprehensive written summary of findings so that issues can be shared with the Operational Areas prior to submission to client.
  • Monitors the UMAudit group mailbox throughout the day.  As audit and materials are requested by client, initiates the audit setup process
  • Enters audit summary information into the Optum eGRC tracking system and the OrthoNet Sharepoint site,
  • Completes internal reporting, to include audit notices and status reports
  • Participates in on-site/webinar audits;, provides case navigation during audit, as needed. 
  • Summarizes issues identified on audit and maintains detailed documentation to track internal corrective action steps and evidence of corrections from the operations areas. 
Monitoring Activities
  • Utilizing data reports, system verification methods, and monitoring reports, identifies potential operational deficiencies and communicates necessary corrections to ensure conformance with compliance metrics.
  • Conducting one-on-one training with operations teams to ensure there is awareness of appropriate workflow and the impact of non-compliance
  • Complete management reports that summarize monitoring activities, results and corrections taken.
Focused Audits
  • Independently conducts client focused audits, as assigned, to identify operational compliance with regulatory / compliance requirements, processes and client corrective action plans
  • Analyzes results by standard / requirement to identify trends and /or adverse findings
  • Summarizes findings and develops recommendations based on audit results

Escalates issues to appropriate Audit department management, as needed

Departmental Functions
  • Attends the weekly Audit Operations team meeting.  Completes the meeting minutes and the issues tracking log.
  • Presents results of monitoring activities / focused audits to Audit team, and at Audit Operations team meetings, as applicable
  • Reviews monthly client reporting universes / reports and facilitates corrections with operational teams, prior to universe submission.
  • Other duties as assigned  

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Posted: 2020-09-25 Expires: 2020-10-30

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Senior Audit Specialist- White Plains, NY or possible Telecommute (local candidates only)

UnitedHealth Group
White Plains, NY 10601

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