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Job Posting Title
Client Audit Advisor – Remote
Job Description Summary
Job Description
As a member of the Client Audit Management (CAM) team, the Client Audit Advisor is accountable for managing regulatory and/or client-initiated audits. This role maintains a thorough understanding of the purpose and protocols of various audit types and serves as a CAM process/subject matter expert supporting the navigation of the end-to-end audit process. The Advisor seeks and obtains additional expertise as indicated from respective Compliance and operational subject matter experts to meet the applicable regulatory, client, and/or functional audit expectations and provides mentorship, training and support to the Client Audit Specialists and/or Analysts. This role may also provide strategic advice and consultation regarding audit management to CAM and business partners.
Responsibilities
- Serve as internal expert for various regulatory and/or client-initiated audit types, processes and protocols; assess audit process documentation and data files and identify and consult on department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained; serve as trainer and mentor for the Client Audit Specialists and Analysts
- Review and interpret audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request; support CAM leadership in determining audit assignments, evaluating complexity, audit status and team capacity
- Develop and maintain key internal and external relationships to effectively provide audit management consultation regarding the streamlining of work activity, creation of efficiencies, and promoting consistent, timely and accurate completion, reporting, or submission of audit deliverables
- Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings
- Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes
- Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders and department leadership as necessary; serve as peer reviewer and provide quality checks for CAM staff
- Demonstrate high-level project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, from the point of audit intake through the entire audit
- Conduct operational audit management training to support audit readiness throughout the organization and support CAM onboarding and staff development
- Other duties as assigned
Minimum Qualifications
- Bachelor’s degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
- 5 years of relevant work experience in compliance, operations, or external audit within a regulated environment
- Must be eligible to work in the United States without need for work visa or residency sponsorship
Additional Qualifications
- Strong verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings
- Excellent interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities
- Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy
- Strong organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
- Agility and adaptability to change and navigate in a dynamic, fast-paced, intense, and matrix environment
- Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence
- Advanced proficiency in Microsoft Office Suite (Word, Excel, Power Point, Visio and Access)
Preferred Qualifications
- Health insurance/PBM operations and/or contract audit experience
- Experience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefit
- Project management experience
- Certification or licensure in a related area of expertise (e.g., Pharmacy Technician, CCEP or HCCA certification)
Minimum Physical Job Requirements
- Minimal travel may be required
- Ability to work a flexible schedule outside of Prime’s core business hours to occasionally accommodate different time zones and during critical client audits
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
Reporting Structure
- Reports to a Manager in the Compliance department
Responsibilities
Work Experience
Work Experience – Required:
Work Experience – Preferred:
Education
Education – Required:
Education – Preferred:
Certifications
Certifications – Required:
Certifications – Preferred:Potential pay for this position ranges from $73,100.00 – $109,500.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
