Carefirst md jobs that perform plan audits for cms

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Establish and ensure monitoring of Delegated vendors for continuous monitoring purposes for complying with all applicate Medicaid regulations, as well as internal policies. Govern and support associates in the completion of third party and control assessments, including self-assessments, to ensure the adequacy of controls in place to safeguard the organization, including tracking, monitoring, and managing issues identified. Maintain documentation for re-performance ability, including leveraging the Governance Risk and Compliance GRC tool and repository e.

Leadership and DevelopmentResponsible for mentoring more junior associatesMaintains accountability for the accuracy of information maintained within the centralized repository. Maintains responsibility for timely escalation of concerns identified during risk and control assessments to the IRM Director and the Medicare and Medicaid Compliance Officer.

The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job. Incumbents perform other related duties assigned.

Understanding of legal requirements and health insurance operationsPossess or in the process of obtaining a relevant risk or business certification e. Problem solver who works independently and within a team using interpersonal skills, including excellent oral and written communication skills. Understands and possesses general project management skills relevant to performing assessment functions and responsibilities.

Ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines and workloads that can be varied for extended periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

Considerable judgment, tact, initiative, accuracy, trustworthiness and integrity. 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. The associate is primarily seated while performing the duties of the position. Act as the liaison between the group customer s auditor and CareFirst operational areas. Obtain and evaluate an audit s scope letter, query, claim samples and other provided or requested items.

After ensuring understanding of the issue s , provide requirements, feedback or findings to the appropriate business units. Communicate with the responding operational area to obtain detailed responses to audit findings. Review and evaluate responsiveness and comprehensiveness of replies. To the extent possible, ensure responses are received on a timely basis.

Prepare follow-up documents, as necessary, prior to submission to the auditors. Obtain, review and prepare audit responses for inclusion in draft and final reports. Review audit findings with appropriate management staff to ensure accuracy.

Perform subsequent follow-up reviews related to group benefit audit findings and state regulatory audit findings to ensure that the Company has successfully and consistently implemented corrective actions. Report findings and observations. Review customer's contracts for audit rights, performance guarantees and other clauses that affect audit performance outcomes.

Using analytical and problem resolution skills, apply Continuous Quality Improvement principles to system, departmental, data and other relevant problems impacting audit and reporting requirements or performance.

Must have excellent written and oral communications skills, analytical and computer capabilities. Minimum of 3 years experience in health care administration, claims, services, health policy or related field. Must have years audit experience, preferably operational or compliance audit. Ability to write detailed memos and responses to audit issues. Excellent interpersonal skills. Ability to organize large amounts of data and 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.

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. 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.

The associate is primarily seated while performing the duties of the position.

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Caresource preferred drug list 2021	More jobs in Baltimore, Maryland General Business about 1 hour ago. Terms and Privacy Policy. Baltimore, Maryland. Review customer's contracts for audit rights, performance guarantees and plzn clauses that affect audit performance outcomes. Using analytical and problem resolution skills, go here Continuous Quality Improvement principles to system, departmental, data and other relevant problems impacting audit and reporting requirements or performance. Type: Full Time.
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Carefirst md jobs that perform plan audits for cms	Tempe, Arizona. Hire Range Disclaimer Actual salary will be based on relevant job experience and go here history. Specifically, the IRM team https://menardsrebateformtm.com/2017-does-caresource-cover-flu-vaccine-for-adults/6575-disclosures-to-the-centers-for-medicare-and-medicaid-services.php responsible for identifying and mitigating risks; managing controls and safeguards to minimize the impact of potential and existing risks affecting the organization; ensuring compliance with laws, regulations, and organization frameworks; and monitoring and effectuating remediation of issues identified. The intent of this list of primary duties is to provide a representative summary of the major duties and responsibilities of this job. Must have years audit experience, preferably operational or compliance audit. Work schedule flexibility is necessary to support the audit and regulatory processes.

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