Medical Mutual of Ohio Manager Medicare Advantage Audits in Cleveland, Ohio

The Manager of Medicare Advantage Audits manages the Medicare Advantage Audit team in the planning, executing and reporting of Medicare Advantage Audits. This position also serves as the coordinator for Medicare Advantage regulatory audits by CMS or a CMS Contractor. The manager performs the oversight of the daily operation of the Medicare Advantage Compliance Audit Program and all compliance audit related activities for the Company’s Medicare Advantage (Part C) and Prescription Drug (Part D) health plan programs. This position ensures that there is standardization across the various audits conducted of the various Medicare Advantage business areas and conducts research; performs internal reviews; and identifies compliance trends that require ad hoc audits. The manager will develop dashboards for reporting data to leadership based on the Medicare Managed Care Manual (MMCM) requirements. Develop risk management strategies for inclusion on the annual audit work plan that correlates to the annual risk assessment and prepares the organization for audits by external regulators.

• Medicare Advantage Audit Planning and standardization. Development of the annual audit and monitoring work plan. Tracking and trending audit findings and ensuring consistent reporting of identified deficiencies. Assisting in the determination of audit elements and methodology based on organizational risk and identified issues. Oversight of audit tool kit development and strategic timing of audits.

• Assist the Medicare Advantage Audit Team in conducting audits and partnering with Operational area clients to maximize organizational efficiencies. Serve as the audit team strategic partner to Medicare Advantage business areas. Develop and implement business process improvements based on consistent findings across the organization. Determining which areas and or processes is to be included in audits and who are the key stakeholders. Assist with the categorization of audit findings, development of audit recommendations and creation of corrective action plans (CAPs). Reviewing preliminary audit reports and providing comments for reporting to leadership. Performs gap analysis of operational processes in preparation for audits by external regulators.

• Performs coordination of regulatory audit duties to ensure the efficient and timely submission of document request. (may include, but not limited to, verifying and tracking data from operational areas, producing compliance deliverables, Reviewing data submissions for accuracy, compiling materials, uploading deliverables to regulator etc.).

• Managing Medicare Advantage Team Staff. Managing staff to ensure the effective and timely completions of Medicare Advantage audits.

• Chair and participates in key divisional team meetings and task which add value to the Division. Represent the audit team in the Medicare Advantage Compliance Committee meeting and other compliance leadership meetings. Present audit findings, dashboard data and organizational trends.

· Bachelor’s degree in healthcare, auditing or a related area.

· 8 Years of Auditing Experience with at least 3 years in the area of Medicare Advantage auditing.

· Demonstrated knowledge of Medicare Advantage Compliance requirements.

· Certification in Healthcare Compliance (CHC) or Certified Internal Audit (CIA) required or ability to receive within 2 years of hire.

· Strong knowledge of Medicare Advantage Part C and D requirements.

· Ability to think analytically

· Ability to handle confidential material.

· Ability to perform effectively in a fast paced setting with minimal supervision.

· Ability to use sound judgment and knowledge of departmental operations in performing auditing duties and making decisions.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

  • Top Workplace in Northeast Ohio. Seven years in a row we've received this recognition!

  • On-site wellness center at most locations. Enjoy personal trainers, towel service, locker room, weight room, elliptical machines, and a variety of classes!

  • On-site cafeteria serving hot breakfast and lunch, at most locations. Choices ranging from salad bar, made to order, hot and cold sandwiches, or a variety of entrees cooked fresh daily. Convenience store at most locations

  • Employee discount program. Discounts at many places in and around town, just for being a Medical Mutual team member

  • Business casual attire

Excellent Benefits and Compensation:

  • Competitive compensation plans

  • Employee bonus program

  • 401(k) with company match and an additional company contribution

  • Excellent medical, dental, vision, and disability insurance

An Investment in You:

  • Career development programs and classes

  • Mentoring and coaching to help you advance

  • Education reimbursement up to $5K per year

About Medical Mutual:

We strive to create peace of mind. Our customers can trust us to do things right and to help them get value from their health plan. We're the largest health insurer in Ohio and for 80 years, we've been serving our members and the Ohio communities where they live and work. Medical Mutual is a Top Place to Work in Northeast Ohio with exceptional career opportunities that offer challenge, growth and a great work/life balance. We want talented, innovative, and driven people to help us continue to be the best health insurance choice of Ohioans and help make Ohio the best it can be! Our headquarter building is located in the heart of downtown Cleveland and we have multiple offices throughout the state. Join us at one near you!

At Medical Mutual we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.

We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

Title: Manager Medicare Advantage Audits

Location: OH-Cleveland

Requisition ID: 1800119