Sr. Audit Project Consultant REMOTE

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Southfield, USA


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

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Competitive Compensation and Benefits Package

Overview: <br />This position is responsible for supporting Advantasure Appeals and Grievances Department by assisting leaders in regulatory and client reporting, audit monitoring, and maintenance of regulatory and client requirements (e.g., Medicare Advantage and Prescription Drug requirements in accordance with CMS, appeals and grievances requirements, etc.). Consults with business areas and other subject matter experts to identify compliance/client requirements, assess risks, and recommend compliant solutions that support business goals. This position acts as subject matter expert on applicable reporting regulations and audit protocols (e.g., CMS, Medicare Advantage, etc.), related training and awareness programs, and responding to applicable compliance-related inquiries (e.g., HPMS reporting, regulatory audits, data validation audits, etc.).<br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards. Field position.&nbsp;</p>
Responsibilities: <br /> <p><strong>Senior Audit Project Consultant</strong><strong>:</strong></p> <ul> <li>Leads preparation for regulatory reporting and audit activity and A&amp;G-related compliance programs.</li> <li>Leads cross-functional teams comprised of various internal customers and client resources.</li> <li>Lead complex development initiatives. Manages teams and ensures that project resources are utilized in an effective and efficient manner. Ensure project goals are met or exceeded via the facilitation and resolution of barriers prohibiting the progress of projects.</li> <li>Plan projects, including the concept, design, planning, project scope, cost and benefits, testing, acceptance, implementation and post-implementation review of project deliverables.</li> <li>Recommends and implements process changes to increase project execution performance.</li> <li>Partners with, and influences as necessary, subject matter experts.</li> <li>Provides assistance and mentors staff on project management-related issues.</li> <li>Reviews system and tools to ensure quality and efficient implementation of development and enhancement efforts.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION OR EQUIVALENT EXPERIENCE:</strong></p> <ul> <li>Bachelor&rsquo;s degree in a related field required.</li> <li>Master&rsquo;s degree in Business Administration and additional related certifications preferred. &nbsp;</li> <li>Relevant combination of education and experience may be considered in lieu of degree.&nbsp;</li> <li>Certification or progress toward certification, such as Compliance Certification Board (CCB), is highly preferred and encouraged.<strong>&nbsp;</strong></li> <li>Project Management/Project Management Certificate (PMP) preferred.</li> </ul> <p>&nbsp;</p> <p><strong>Senior Audit Project Consultant:</strong></p> <ul> <li>7 years in related healthcare field, Medicare Advantage preferred which may include experience in technical/systems, information security, compliance and/or audit.</li> <li>5 years of project management experience in health plan operations or related field required.</li> <li>Leadership/supervisory experience and/or analytical experience with data, systems, and operations.</li> </ul> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Ability to develop and present complex materials in a clear, concise and persuasive manner.</li> <li>Working knowledge of HIPAA legislation, privacy rules, security standards, or federal regulations related to Medicare Parts C and D, or advanced knowledge of risk assessment concepts and generally accepted auditing principles.</li> <li>Ability to plan, organize, direct and control projects while exercising high ethical standards and good judgment.</li> <li>Ability to define analysis needed and complete work when little direction is provided.</li> <li>Excellent analytical, organizational, interpersonal, problem-solving, written and verbal communication skills, as well and the ability to apply concepts to practical situations.</li> <li>Ability to work independently with minimal supervision, within a team environment and handle multiple assignments.</li> <li>Working knowledge of PC applications (Word, Excel, PowerPoint and Outlook).</li> <li>Other related skills and/or abilities may be required to perform this job.</li> <li>Knowledge of program management</li> <li>Demonstrated proficiency and experience with project management applications, templates, development tools, and analysis tools</li> <li>Demonstrated knowledge and experience planning and leading high-risk and complex projects</li> </ul>