Manager Audit Readiness

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position manages the execution of the annual Federal Govt initiated regulatory audits and serves as the organizational liaison with CMS. This position collaborates with all levels of business partners across the Enterprise to resolve negative audit results which are subject to all levels of corrective action from CMS. The incumbent will lead a team of analysts that will review the findings, which can include civil monetary penalty, discontinuation of Medicare contracts, reject plans for expansion, suspended market activities and warning notices. This position also manages audit readiness across the Enterprise. This is done by hosting “mock’ audits with the business that align with published audit protocols.

Job Responsibilities:

• Functions as the Organizational liaison with federal auditors, and ensures organizational deliverables are

  aligned with CMS expectations.

• Compiles business responses, universe data, hosts audit sessions, secures executive agreements and

  signs off.

• Initiates corrective actions based on findings, provides guidance to business stakeholders regarding the

  audit protocols and expectations and will manage the compliance regulatory staff performance.

• Manages and updates the CMS audit playbook to ensure readiness appropriate key stakeholders and day

  1-day 60 step by step expectations, as well as manages “mock program audit” reviews quarterly with the

  business owners.

• Develops the Annual Audit Readiness Plan in collaboration with the Director, Regulatory Compliance, and

  Braven Medicare Compliance Officer, as well as prepares and disseminates Annual Audit Readiness results

  with the Director, Regulatory Compliance and Braven Medicare Compliance Officer.

• Disseminates the CMS Audits and Compliance Audit Readiness Plan to the affected business stakeholders

  and provides guidance related to same.

• Manages the CMS Audits and Annual Audit Readiness Plan in collaboration with the Director, Regulatory

  Compliance and Horizon & Braven Medicare Compliance Officer.

• Prepares and reports on the Braven Compliance Oversight Committee for Audit Readiness Program.

• Partners with the Braven Chief Operating Officer and Medicare Compliance Officer on Mock Audits for

  oversight activities.

• Collaborate with Regulatory Audit and Internal Audit to ensure alignment with regulatory requirements.

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Education/Experience:

• Minimum high school diploma or GED

• Bachelor’s degree or equivalent work experience in lieu of degree required.

• Requires a minimum of five (5) years of relevant experience, preferably in Medicare Compliance, and Monitoring/

  audit readiness.

• Experience managing teams or leading project work/initiatives preferred.

Knowledge:

• Health insurance industry knowledge; including Medicare, Medicaid, or Commercial health plan requirements

• Prefers federal government audit knowledge

• Prefers analytics experience

• Prefer experience with CMS Program Aud

Skills and Abilities:

• Organization and management of multiple priorities
• Analytical
• Strong written and verbal communication skills
• Attention to detail
• Problem solving

Salary Range:

$94,900 - $129,570

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.