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    Compliance Auditor - New York, United States - MJHS Health System

    MJHS Health System
    MJHS Health System New York, United States

    2 weeks ago

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    Description
    Req #: 1851

    Job ID: 13399


    Job Location:
    New York, NY

    Zip Code: 10040


    Category:
    Compliance


    Agency:
    Elderplan


    Status:
    Regular Full-Time


    Office:
    Office-based


    Salary:
    $77, $92,519.21 per year

    The challenges of affordable healthcare continue to create new opportunities.

    Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.

    These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.


    Why work for MJHS?:


    When you work with us you will receive comprehensive and affordable health and financial benefits, in addition to generous paid vacation, personal and holiday time that you won't find at our competitors.

    Do you receive a paid day off for your birthday now? No? You will here You will also receive the training, tuition assistance and career development you desire to help you achieve your career goals.

    You take care of our patients, residents and health plan members, and we will take care of the rest


    Benefits include:

    • Tuition Reimbursement for all full and part-time staff
    • Generous paid time off
    • Affordable medical, dental and vision coverage for employee and family members
    • Two retirement plans 403(b) AND Employer Paid Pension
    • Flexible spending
    • And MORE
    MJHS companies are qualified employers under the Federal Government's Paid Student Loan Forgiveness Program (PSLF)


    Responsibilities:


    Under the direction of the Compliance Officer and Compliance Department management, the Compliance Auditor is responsible for working independently on assigned projects to ensure health plan compliance with Medicare (Part C and D), NYS Medicaid and MLTC regulations.

    Initiates and perform audits and monitoring activities of various health plan operations, such as appeals and grievances, claims, medical management, customer service, provider relations and contracting, sales and enrollment, and other functions to ensure proper compliance with governmental regulations and health plan policies.


    Qualifications:

    • Bachelor's Degree required.
    • Three or more years of experience in auditing required.
    • Experience in compliance, healthcare, and Medicare and Medicaid managed care is helpful and preferred.
    • Additionally, experience in facilitating regulatory audits, such as CMS, DOH and DFS audits is helpful and preferred.
    • Ability to independently conduct audits;
    • Ability to develop and implement audit plans, protocols, corrective action plans, root cause analyses, and impact reports;
    • Ability to interact with all levels of management, as well as federal and state regulatory agencies;
    • Excellent verbal and written communication skills essential;
    • Proficiency in Excel and experience in data analysis, charting, and dashboards.
    Apply
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