3 External Audits jobs in the United States

Compliance Analyst II - External Audit

45444 Dayton, Ohio CareSource

Posted 4 days ago

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Job Description

Job Summary:

The Compliance Analyst II position is a professional compliance role responsible for supporting the Compliance Program by collaborating and overseeing high risk areas to ensure that the compliance program is effective and efficient in identifying, preventing, detecting, and correcting noncompliance.

Essential Functions:

Compliance Prevention:
  • Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements
  • Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing
  • Collaborate with internal business owners to ensure implementation of the health plan's business and contractual requirements
  • Work with Compliance leadership to interpret regulations and provide related guidance
  • Assists in review and dissemination to team of Regulatory Distribution Management items (new and changing regulations); works to understand and provide expertise to team on these items and the impact to our work with high-risk business areas
Compliance Detection:
  • Provide Compliance Program support with audit and monitoring, corrective action plan management, data analytics and other projects to ensure proper execution of the Compliance Program workplan and priorities
  • Analyze relevant business and/or delegate/FDR performance data to ensure compliance with requirements and prepare reports for leadership and business owners
  • Proactively use analytic and research skills to identify potential areas of risk to CareSource and make recommendations or escalate to Compliance Management for issue management, external audit enforcement trending, and related industry corrective actions
  • Support and/or coordinate audit activities with impacted business owners to ensure adequate representation from subject matter experts (SME) for external reviews and audits
  • Proactively maintain documentation, data universes, responses and other written or electronic materials using the proper compliance tools and in accordance with Corporate Compliance protocols
Compliance Correction:
  • Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management
  • Ensure timely, complete, accurate, and concise documentation of corrective action plans, case summaries and executive summaries for all compliance matters. Documentation must include problem, history, mitigation or corrective actions, and recommendations for ongoing monitoring or process improvement.
Account Relationship
  • Build and maintain positive and strategic relationships with internal and external stakeholders
  • Attend all required state regulator meetings and communicate outcomes, manage deliverables, and provide guidance to business areas
  • Perform any other job duties as requested
Education and Experience:
  • Bachelor's degree in business or related field, or equivalent years of relevant work experience is required
  • Minimum of three (3) years of compliance and/or regulatory experience including one (1) year in Government Program products is required
Competencies, Knowledge and Skills:
  • Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities
  • Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred
  • Data analysis ability to produce meaningful insight and drive appropriate action
  • Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)
  • Proven knowledge of internal and external audit functions and procedures
  • Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement
  • Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus
  • Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal Leadership at all levels, internal and external Legal Counsel, Corporate Compliance, State and Federal Regulators
  • Advanced organizational, project management and scheduling skills
  • Strong decision making and problem-solving skills
  • Ability to work independently and within a team environment
  • Demonstrated success in working in a matrixed environment
  • Detail orientated with focus on maintaining accurate information in tools as required
  • Demonstrated critical thinking skills
  • Negotiation skills/experience
  • Time management skills including creation and maintenance of project timelines
  • Advanced level experience in Microsoft Word, Excel and PowerPoint
Licensure and Certification:
  • Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) preferred
  • Current, unrestricted clinical licensure to include: LPN in state of service, Registered Nurse (RN) in the state of service, or other clinical licensure may be desired for positions with a clinical focus
  • Functional business licensure/ certification may be desired as they apply to organizational operations (e.g. Claims coding certification, analytics certification, etc.)
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$70,800.00 - $113,200.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):
Salary

Organization Level Competencies
  • Create an Inclusive Environment
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business


This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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Project Manager II - External Audit

65108 Jefferson City, Missouri Centene Corporation

Posted 20 days ago

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Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
**Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.**
**Position Purpose:** Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives.
+ Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment, and closure.
+ Utilize corporate and industry standard project management tools and techniques to effectively manage projects.
+ Assist with establishment and maintenance of corporate project management methodology and other department procedures.
+ Maintain detailed project documentation including meeting minutes, action items, issues lists, and risk management plans.
+ Effectively communicate project status to all stakeholders.
+ Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks.
+ Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives.
+ Provide functional and technical knowledge across multiple business and technical areas.
+ Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.
+ Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics.
**Education/Experience:**
+ Bachelor's degree in related area or equivalent experience.
+ 3+ years of project management experience.
+ Experience working with and leading diverse groups and matrix managed environments.
+ Proficient with project management tools, MS-Project or other project management software, and MS-Office applications.
+ Healthcare experience preferred.
**License/Certification:** PMP or CAPM certification preferred.
Pay Range: $68,700.00 - $123,700.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Asset and Wealth Management External Audit - Regulatory Reporting Specialist - Manager

02133 Boston, Kentucky PwC

Posted 3 days ago

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Job Description

**Specialty/Competency:** Assurance
**Industry/Sector:** Asset and Wealth Management
**Time Type:** Full time
**Travel Requirements:** Up to 20%
At PwC, our people in risk and compliance focus on maintaining regulatory compliance and managing risks for clients, providing advice, and solutions. They help organisations navigate complex regulatory landscapes and enhance their internal controls to mitigate risks effectively.
In regulatory risk compliance at PwC, you will focus on confirming adherence to regulatory requirements and mitigating risks for clients. You will provide guidance on compliance strategies and help clients navigate complex regulatory landscapes.
Enhancing your leadership style, you motivate, develop and inspire others to deliver quality. You are responsible for coaching, leveraging team member's unique strengths, and managing performance to deliver on client expectations. With your growing knowledge of how business works, you play an important role in identifying opportunities that contribute to the success of our Firm. You are expected to lead with integrity and authenticity, articulating our purpose and values in a meaningful way. You embrace technology and innovation to enhance your delivery and encourage others to do the same.
Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:
+ Analyse and identify the linkages and interactions between the component parts of an entire system.
+ Take ownership of projects, ensuring their successful planning, budgeting, execution, and completion.
+ Partner with team leadership to ensure collective ownership of quality, timelines, and deliverables.
+ Develop skills outside your comfort zone, and encourage others to do the same.
+ Effectively mentor others.
+ Use the review of work as an opportunity to deepen the expertise of team members.
+ Address conflicts or issues, engaging in difficult conversations with clients, team members and other stakeholders, escalating where appropriate.
+ Uphold and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firm's code of conduct, and independence requirements.
The Opportunity
As part of the Regulatory Strategy and Governance team you lead the development and execution of government and regulatory affairs strategies. As a Manager you guide the execution of policy risk and regulatory profile projects, maintaining a customer-centric approach that supports PwC's goals and vision. You interact effectively with policymakers and non-governmental stakeholders to manage the impact of emerging policies on clients' businesses.
Responsibilities
- Lead the development and execution of government and regulatory affairs strategies
- Manage client accounts with a focus on strategic planning
- Mentor junior staff to enhance their skills and performance
- Guide the execution of policy risk and regulatory profile projects
- Interact effectively with policymakers and stakeholders
- Identify challenges and recommend solutions
- Assure a customer-centric approach in regulatory operations
- Assure top-quality deliverables and adherence to timelines
What You Must Have
- Bachelor's Degree
- 6 years of experience
What Sets You Apart
- Master's Degree in Business Administration/Management, Business Studies, Economics, Law, Managerial Economics, Political Science, Politics, Public Administration, Public Policy Analysis preferred
- Mastery in policy and regulatory issues
- Experience in government relations strategies
- Knowledge of legislative and regulatory processes
- Ability to lead complex projects
- Advanced written and oral communication skills
- Experience in mentoring and motivating teams
- Ability to assess business and economic implications of policy
Learn more about how we work: does not intend to hire experienced or entry level job seekers who will need, now or in the future, PwC sponsorship through the H-1B lottery, except as set forth within the following policy: PwC is an equal opportunity employer, all qualified applicants will receive consideration for employment at PwC without regard to race; color; religion; national origin; sex (including pregnancy, sexual orientation, and gender identity); age; disability; genetic information (including family medical history); veteran, marital, or citizenship status; or, any other status protected by law. 
For only those qualified applicants that are impacted by the Los Angeles County Fair Chance Ordinance for Employers, the Los Angeles' Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, San Diego County Fair Chance Ordinance, and the California Fair Chance Act, where applicable, arrest or conviction records will be considered for Employment in accordance with these laws. At PwC, we recognize that conviction records may have a direct, adverse, and negative relationship to responsibilities such as accessing sensitive company or customer information, handling proprietary assets, or collaborating closely with team members. We evaluate these factors thoughtfully to establish a secure and trusted workplace for all.
The salary range for this position is: $99,000 - $297,000, plus individuals may be eligible for an annual discretionary bonus. For roles that are based in Maryland, this is the listed salary range for this position. Actual compensation within the range will be dependent upon the individual's skills, experience, qualifications and location, and applicable employment laws. PwC offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation, personal and family sick leave, and more. To view our benefits at a glance, please visit the following link:
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