Senior Manager of External Audits

Job Ref: TE0038 Category: Compliance and Regulatory Department: MHP CORPORATE COMPLIANCE Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Work Arrangement: Remote Salary Range: $125,000.00 - $140,000.00 Position Overview Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. Reporting to the Senior Director of Corporate Compliance and Privacy, the Senior Manager of External Audits plays an essential role in supporting the Compliance Program and is responsible for overseeing external audits. The Senior Manager will lead and execute external audit engagements and drive high-quality, data-driven responses to regulatory agencies. In this role, the Senior Manager will be involved in all external audits from end-to-end, analyzing data files from regulators and internal business areas, engaging business leaders to obtain documentation and resolve issues, and preparing clear responses for submission. Duties & Responsibilities

• Lead and execute external audits from regulatory agencies such as NYS Office of State Comptroller (OSC), New York State Office of Medicaid Inspector General (OMIG), Centers for Medicare and Medicaid Services (CMS), New York State Department of Health (DOH), New York State Department of Financial Services (DFS), etc.
• Proactively engage with internal business areas and vendors to gather evidence, clarify processes and drive a timely response.
• Analyze datasets received from regulators to assist business areas and/or vendors with their reviews.
• Streamlines workflow to ensure timeliness and accuracy of compilation processes.
• Prepare and review audit deliverables, response/dispute letters, and corrective action plans.
• Mentor and supervisor the Manager of External Audits; set priorities and ensure consistent quality.
• Responsible for the development and maintenance of tools and supporting documentation related to the external auditing process.
• Provides primary support during full operational audits.
• Communicates audit findings and actions required through various reporting mechanisms.
• Upon identification of non-compliance, provides support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review.
• Plays a critical role in driving the progress for corrective actions throughout the organization.
• Refers compliance matters, when necessary, to the appropriate Compliance teams to ensure proper investigation of issues.
• Other activities as assigned by the Senior Director of Corporate Compliance.

Minimum Qualifications

• Bachelor’s degree from an accredited institution
• 5-7 years of experience in managed care organization compliance/auditing or healthcare compliance
• Experience with managed care, Medicare and federal and/or state regulations and quality improvement.
• Healthcare Compliance or Internal Audit Certification (preferred)

Professional Competencies

• Ability to function independently with limited direction.
• Advanced Excel skills; experience manipulating large data sets and pivot tables.
• In depth knowledge of health care policy environments or policy related roles with demonstrated knowledge of leading and supporting cross-departmental employee stakeholders.
• Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills.
• Excellent written English; able to produce polished, defensible responses.
• Excellent oral communication skills, with ability to convey complex information in an accessible way as well as prepare and give presentations to diverse audiences.
• Demonstrated ability to manage multiple projects, including managing departmental workload in line with the organizational strategy, successfully managing working groups, and proven project management skills.
• Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team.
• Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools.
• The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously, manage multiple projects.
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary.

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