Regulatory Compliance Auditor
The speed of technology. The influx of data. Shifting regulations. Increased customer expectations.
That's where you'll find DST, helping clients find opportunity in ever-changing and complex customer, business, and regulatory requirements. Mastering complexity is a constantly changing and evolving challenge one that only a few people can embrace and thrive upon.
If you see your opportunity in complexity, then we are the right fit for you.
Job Description:
Organizational Overview
DST Health Solutions provides healthcare reform through a full range of BPO and turnkey healthcare administration solutions. Our solutions, combined with our health outcomes optimization solutions, include advanced technologies and strategic consulting services designed to optimize our customer's outcomes, revenues, and managing their risk. We help client's master complexity in the world's most demanding industries to ensure they continually stay ahead of the ever-changing customer requirements.
Role Overview
The Regulatory Compliance Auditor is responsible for coordinating and performing compliance audits of delegated health plan activities in accordance with established compliance and audit protocols to identify vulnerabilities and to ensure strict adherence to regulatory requirements.
Responsibilities
Assist in establishing detailed audit programs to monitor and assess health plan operations and policies and procedures within all major functional areas including customer service, enrollment and eligibility and claims processing. Assume responsibility for all aspects of assigned audits from the development of the scope document to the creation of the final audit summary report for management review.
Coordinate and/or perform compliance audits of delegated services provided to Medicare Advantage (MA) and/or Prescription Drug Plan (PDP) sponsors as well as other delegated activities in accordance with established compliance audit protocols to identify program vulnerabilities and to ensure strict adherence to regulatory requirements
During audits, will review policies and procedures, works flows, organizational charts, encounter and claims related documents. Will conduct walk-throughs of various departments and processes to ensure that each step of the processes are in order and compliant with delegated and regulatory requirements.
Prepare audit reports with details of findings and proposed corrective actions, when necessary
Utilize appropriate statistical methods and standard auditing procedures when appropriate (determination of appropriate sample size, random selection, establishment of materiality levels)
Work with quality and compliance departments to develop baseline data in order to identify outliers and trends.
Stay abreast of developments in industry auditing standards as well as applicable federal and state guidelines, policies and procedures.
Qualifications
Minimal:
High school diploma or equivalent
3 years applicable regulatory compliance-related work experience
Optimal:
Bachelor's degree in Business/Healthcare Administration, Accountancy or Finance preferred
5 years regulatory research, requirements gathering, business analysis, or related experience in the healthcare payer industry
Experience leading projects or business groups and facilitating cross-functional team meetings
Experience in healthcare quality, compliance, government programs, or internal audit in a health insurance company or related health care company a strong plus
Medicare Advantage or Part D Prescription Drug program expertise desired, including understanding of compliance requirements, monitoring guidelines, and regulatory standards
Experience in the development of effective audit programs and the use of stand auditing techniques
Experience performing audits of various health plan operations including enrollment, claims processes, customer service and other functions relating to proper compliance with governmental regulations, laws and policies
Must have sound judgment and impeccable integrity
Must enjoy and be able to multi-task in a very fast-paced organization with little direct oversight
Must be able to handle confidential information appropriately and know when to escalate issues
Should have excellent project management skills, be highly organized and focused on delivering results
Knowledge of standard health plan organization structures, workflows and operating procedures helpful
Must be able to work cross functionally in order to gain sufficient knowledge and information relative to assigned audits
Ability to communicate effectively, both orally and in writing
Ability to analyze complex non-financial data, identify process gaps, provide recommendations for mitigating the gaps, and develop meaningful reports for internal and external use
Ability to effectively utilize Microsoft Excel and Access to track and manipulate data
Must be able to work overtime as needed during peak times or to meet regulatory deadlines
Location:
Birmingham Alabama
DST is an equal opportunity employer and values a diverse and inclusive workplace. All qualified candidates will receive consideration for employment without regard to age, race, color, religion, genetic information, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. For more information about Equal Opportunity in the Workplace please click here and here. DST is committed to working with and providing reasonable accommodation to job applicants with disabilities. If you are a qualified individual with a disability and need an accommodation or accessibility assistance to complete the online application, please contact us at PeopleCenter@dstsystems.com for assistance.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
That's where you'll find DST, helping clients find opportunity in ever-changing and complex customer, business, and regulatory requirements. Mastering complexity is a constantly changing and evolving challenge one that only a few people can embrace and thrive upon.
If you see your opportunity in complexity, then we are the right fit for you.
Job Description:
Organizational Overview
DST Health Solutions provides healthcare reform through a full range of BPO and turnkey healthcare administration solutions. Our solutions, combined with our health outcomes optimization solutions, include advanced technologies and strategic consulting services designed to optimize our customer's outcomes, revenues, and managing their risk. We help client's master complexity in the world's most demanding industries to ensure they continually stay ahead of the ever-changing customer requirements.
Role Overview
The Regulatory Compliance Auditor is responsible for coordinating and performing compliance audits of delegated health plan activities in accordance with established compliance and audit protocols to identify vulnerabilities and to ensure strict adherence to regulatory requirements.
Responsibilities
Assist in establishing detailed audit programs to monitor and assess health plan operations and policies and procedures within all major functional areas including customer service, enrollment and eligibility and claims processing. Assume responsibility for all aspects of assigned audits from the development of the scope document to the creation of the final audit summary report for management review.
Coordinate and/or perform compliance audits of delegated services provided to Medicare Advantage (MA) and/or Prescription Drug Plan (PDP) sponsors as well as other delegated activities in accordance with established compliance audit protocols to identify program vulnerabilities and to ensure strict adherence to regulatory requirements
During audits, will review policies and procedures, works flows, organizational charts, encounter and claims related documents. Will conduct walk-throughs of various departments and processes to ensure that each step of the processes are in order and compliant with delegated and regulatory requirements.
Prepare audit reports with details of findings and proposed corrective actions, when necessary
Utilize appropriate statistical methods and standard auditing procedures when appropriate (determination of appropriate sample size, random selection, establishment of materiality levels)
Work with quality and compliance departments to develop baseline data in order to identify outliers and trends.
Stay abreast of developments in industry auditing standards as well as applicable federal and state guidelines, policies and procedures.
Qualifications
Minimal:
High school diploma or equivalent
3 years applicable regulatory compliance-related work experience
Optimal:
Bachelor's degree in Business/Healthcare Administration, Accountancy or Finance preferred
5 years regulatory research, requirements gathering, business analysis, or related experience in the healthcare payer industry
Experience leading projects or business groups and facilitating cross-functional team meetings
Experience in healthcare quality, compliance, government programs, or internal audit in a health insurance company or related health care company a strong plus
Medicare Advantage or Part D Prescription Drug program expertise desired, including understanding of compliance requirements, monitoring guidelines, and regulatory standards
Experience in the development of effective audit programs and the use of stand auditing techniques
Experience performing audits of various health plan operations including enrollment, claims processes, customer service and other functions relating to proper compliance with governmental regulations, laws and policies
Must have sound judgment and impeccable integrity
Must enjoy and be able to multi-task in a very fast-paced organization with little direct oversight
Must be able to handle confidential information appropriately and know when to escalate issues
Should have excellent project management skills, be highly organized and focused on delivering results
Knowledge of standard health plan organization structures, workflows and operating procedures helpful
Must be able to work cross functionally in order to gain sufficient knowledge and information relative to assigned audits
Ability to communicate effectively, both orally and in writing
Ability to analyze complex non-financial data, identify process gaps, provide recommendations for mitigating the gaps, and develop meaningful reports for internal and external use
Ability to effectively utilize Microsoft Excel and Access to track and manipulate data
Must be able to work overtime as needed during peak times or to meet regulatory deadlines
Location:
Birmingham Alabama
DST is an equal opportunity employer and values a diverse and inclusive workplace. All qualified candidates will receive consideration for employment without regard to age, race, color, religion, genetic information, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. For more information about Equal Opportunity in the Workplace please click here and here. DST is committed to working with and providing reasonable accommodation to job applicants with disabilities. If you are a qualified individual with a disability and need an accommodation or accessibility assistance to complete the online application, please contact us at PeopleCenter@dstsystems.com for assistance.
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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