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- Salt Lake City, UT
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Government Program Audit Consultant
Cambia Health Solutions • Salt Lake City, UT
Posted 28 days ago
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Government Program Audit Consultant
Portland, Seattle, Boise OR Salt Lake City
Primary contact for regulator inquiries, audits, and investigations. Builds regulatory relationship through transparency and trustworthiness and by demonstrating Cambia’s commitment to compliance on behalf of the consumer. Investigates regulator’s concerns. Works with business partners across Cambia to coordinate response to regulator inquiries, audits, and investigations. Project manages business partner data and information collection and validation. Collects and submits required information; maintains documents submitted and proof of submission. Drafts and delivers clear, timely, accurate, and effective responses to regulators. Controls and maintains documents and documentation. If compliance issues are identified, coordinates with Compliance analysts and business partners to ensure resolution and to communicate resolution as appropriate to regulator.
Responsibilities & Requirements
- The Government Program Audit Consultant will have a Bachelor’s degree in liberal arts, business or health care field; and at least seven years of experience in project management, investigations, regulatory affairs, compliance, customer service, communications or legal department or equivalent combination of education and job-related work experience.
- Significant and in-depth knowledge of all Cambia health benefit contracts, systems, and processes related to those contracts, including all Cambia claims, clinical, and member systems and data related to Cambia claims, clinical, and member systems.
- Knowledge of insurance laws and regulations applicable to Cambia, including laws applicable to government programs and the administration of those programs.
- Knowledge of regulatory administration and enforcement.
- Familiarity with Centers for Medicare and Medicaid Services (CMS), Office of Program Management (OPM), and other relevant regulators and their practices, and with and auditors and consultants who administer, prepare, and validate regulatory audits.
- Demonstrated project management skills, including high proficiency in tracking and reporting status and deliverables and controlling and maintaining documents
- Demonstrated data collection and validation skills, including proficiency with Excel, Access, and Tableau.
- Demonstrated investigative skills, including effective interviewing.
- Demonstrated analytical and research skills.
- Demonstrated decision-making skills; tolerance of ambiguity.
- Demonstrated writing and verbal communication skills, including ability to interact effectively with all levels of staff and leadership, internally and externally.
- Ability to exercise a high level of judgment, initiative and discretion in confidential and sensitive matters.
- Ability to identify and prioritize workload, and handle multiple tasks simultaneously.
- Demonstrated collaborative and persuasive skills.
- High-level interpersonal skills.
- Knowledge of general office practices and procedures.
- Knowledge of basic mathematics, grammar and techniques of business and legal composition.
- Use of standard office equipment including telephone, personal computer, facsimile machine, calculator, copier.
- Proficiency in Windows PC applications, including Microsoft Word, Outlook, PowerPoint, Sharepoint, and Remedy.
- Proficiency establishing, maintaining, and using SFTP sites for secure data upload.
- Must be able to work with minimal supervision and assume increasingly complex responsibilities.
- Ability to improve processes and systems.
- Ability to collaborate/drive cross-functionally to achieve results/identify and address patterns.
General Functions and Outcomes
- Develops and maintains strong relationships with regulators and external governmental auditors. Demonstrates transparency, trustworthiness, and Cambia’s commitment to compliance on behalf of the consumer.
- Serves as primary contact for regulators’ and external governmental auditors’ concerns, inquiries, audits, and investigations; coordinates investigations and responses.
- Investigates regulators’ and external auditors’ concerns; works with business partners across Cambia to coordinate response to regulator inquiries, audits, and investigations.
- Identifies key business partners and facilitates meetings with them to ensure collaboration and completion. Secures key relationships and actively develops opportunities across Cambia to accomplish this coordination. Collaborates with key Cambia partners and teams.
- Project manages business partner data, document, and information collection and validation. Creates, implements, and monitors project work plans to ensure that tasks are identified and executed, and timelines are met. Controls and maintains documents and documentation.
- Collects and submits required information to regulators and auditors; maintains documents submitted and proof of submission. Drafts and delivers clear, timely, accurate, and effective responses to regulators.
- Implements and maintains appropriate systems and processes to ensure secure and confidential transmission of documents – e.g., SFTP sites for upload.
- Uses independent judgment to draft and deliver clear, timely, accurate, and effective responses to regulators.
- If compliance issues are identified, coordinates with Compliance analysts and business partners to ensure resolution and to communicate resolution as appropriate to regulators and auditors.
- Uses independent judgment to research and respond to inquiries and complaints by regulators and auditors. Determines outcome, if any, based on facts and circumstances of complaint.
- Maintains knowledge of relevant regulations; works with Medicare Compliance Officer and Legal Department as needed for interpretation.
- Represents the company and interacts with all company departments, auditors, and regulators; and takes all appropriate actions to build and maintain trust relationships with such persons.
- Determines trends and escalates issues to leadership and business partners. Collaborates with business partners to identify and address potential areas for future inquiries, audits, and investigations.
- Establishes, maintains, and promulgates policies, procedures, and protocols, including quality protocols and best practices for collection, validation, and preservation of data and document collection.
- Develops and maintains case and document tracking system and processes.
- Drives continuous quality improvement in processes, systems, and personnel.
- Develops and maintains case and document tracking and preservation system.
- Responsibilities extend to Company’s wholly owned or controlled subsidiaries and affiliates.
- Acts with highest standards of integrity and trust.
- Work primarily performed in office environment unless approved for remote work
- Travel may be required, locally or out of state
- May be required to work outside normal hours
At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions.
We have over a century of experience in developing and providing health solutions to serve our members. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.