Coordination of data from outside vendors and internal divisions to ensure complete and accurate ACA compliance, such as EDGE database support, RADV audit, Risk Adjustment and other programs.
- Coordinate cross-functional teams to design and implement financial controls that incorporate consideration of all relevant process and technology touch-points and data exchanges to identify and re-mediate risks to the accuracy of financial data and controls.
- Perform analytics of member/claim data to support Risk Adjustment and maximise results.
- Maintain accurate and concise documentation, developing SOPs for the department
- Provide support to Lead Financial Auditor and advisor during the RADV audit by developing and maintaining reports, support the outreach to provider for medical record request.
- Bachelor’s degree and/or equivalent work experience in a related field demonstrating knowledge of finance, accounting, and/or compliance (CIA, CPA or CFSA a plus)
- 5-7 years in Accounting, creating and/or conducting audits and corresponding plans
- At least 3 years’ experience with actuarial, Healthcare and regulatory compliance
- Strong/Advanced Microsoft Excel skills
- Proven ability in planning and execution of assignments
- Ability to conduct sensitive investigations and maintain confidentiality
- Ability to build strong relationships with all internal and external customers
- Ability to present findings clearly and efficiently
Job Status: Contract/Temporary