Audit Specialist

Summary: Coordinates internal monitoring schedules and performs internal audits to measure compliance with CMS, NAIC and Sterling established standards.

 

Duties and Responsibilities: 

 

1.  Assist the Manager in the development of the annual audit plan and establishing benchmarks for each subject matter area audited.

 

2.  Responsible for knowledge of Centers for Medicare and Medicaid regulations and state requirements regarding approval and distribution of marketing materials. Conduct audits of the advertising, websites and enrollee/policyholder materials according to established state and legal guidelines.

 

3.  Conduct internal audits of Sterling departments in accordance with the scheduled frequency by initiating, performing, reporting and maintaining documentation on the audits of various departments. 

 

4.  Initiate contact with the departments with regards to audits.  Consists of developing scope documents, facilitating meetings and undergoing necessary training in order to obtain a grasp of the subject matter prior to reviewing the data.  Reviewing data consists of policies and procedures, task documents, contracts and working papers.

 

5.  Participate in ongoing process improvement activities.  Perform assigned duties and tasks to meet department and corporate goals, improve operational skills, and increase knowledge. 

 

6.  Other related duties as requested.

 

Knowledge, Skills, and Abilities:

·  Excellent oral and written communication skills

·  Ability to develop positive relationships

·  Strong ability to handle stress and be a team player

·  Strong analytical, interpretive and interpersonal skills

·  Ability to use a computer, including advanced knowledge of MS Word and Excel

·  Ability to organize and prioritize work, meet deadlines and work independently

·  Broad knowledge of and experience in, or understanding of, the health care industry related to Medicare products – Medicare supplement, Medicare Select and Medicare+Choice programs

·  Strong organizational skills

·  Strong attention to detail with emphasis on accuracy

 

Education and Experience:

·  College degree (with coursework in business with statistical and financial training, report writing and public speaking) or related experience (preferably in a medical or insurance related position) of at least two years

·  Minimum one year audit experience

 

Desired:

·  Knowledge of CMS guidelines

·  Knowledge of Medicare guidelines and standards for first dollar processing of Medicare claims.

·  Knowledge of medical coding and terminology.  Familiarity with medical reference books.

·  Knowledge of claims processing flow and procedures including but not limited to, COB, provider and enrollment file functions, medical management, customer service and quality improvement.

·  Knowledge of National Association of Insurance Commissions (NAIC)

 

Essential Functions:

·  Manual dexterity in hands to do extensive keyboarding

·  Requires the ability to sit for extended periods of time

 HOW TO APPLY

 Visit our website: : www.ohmsystems.com and click on the “CAREERS” link to download an application.  Applications and job descriptions are also available at our office location: 2219 Rimland Dr., Bellingham, WA 98226

Sterling Life Insurance Company is an Equal Opportunity Employer, committed to a diverse workforce, M/F/D/V. Employment contingent on successful background check.