Manager, Provider Reimbursement Audit

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Lead a team tasked with comprehensive Medicare, Duals, and Marketplace audit functions, which encompass planning, execution, reporting, and monitoring corrective actions.

• Manage monthly reports for executives and convey audit findings and trends to relevant stakeholders.

• Supervise resource allocation and the development of team members.

• Propel process enhancements that improve quality, compliance, and operational efficiency.

• Oversee operational audits related to claims, provider setup and maintenance, member eligibility, contracting, encounters, provider/member services, and the implementation of new business.

• Manage monthly reporting for claims audit oversight.

• Handle the complete lifecycle of claims audit reporting and upstream operational audits, from gathering requirements to closing audits.

• Administer audit work plans, schedules, resources, and budgets effectively.

• Facilitate the execution of audits and reporting until the closure of audit periods and operational audits.

• Present audit outcomes to leadership and stakeholders from corporate and health plans.

• Assess operational processes and controls to pinpoint non-compliance issues and identify areas for improvement.

• Maintain audit tools to ensure that business requirements are adequately measured during audits.

• Organize cross-functional meetings for corrective action plans to bolster claims quality initiatives.

⛳️ Requirements

• Bachelor's degree in a related discipline or equivalent experience.

• Over 5 years of experience in public accounting, internal audit, or a similar operational role.

• Familiarity with MicroStrategy, ACL, Compliance 360, Microsoft applications (including Excel and Access), Tableau, and claims payment systems is preferred.

• CPA, CIA, or CISA certification is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off along with holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in total compensation.