Remote Senior Compliance Auditor

Summary

Join Abarca as Senior Compliance Auditor and ensure successful completion of assigned audit engagements, manage operational audit activities, and apply audit & monitoring techniques to examine documentation, interview employees, and conduct analysis of data.

Requirements

• Bachelor’s or Master’s degree in Health Services Administration, Public Health, Health Evaluation, Health Economics, Statistics, Science, or a related mathematics field
• 6+ years of experience in Medicare Part D Compliance or Audits
• Experience in PBM Operations
• Experience executing audits to evaluate compliance with CMS regulations and Part D requirements, including but not limited to coverage determinations, appeals, credentialing, PDE submissions, and formulary management
• Demonstrated ability to work in collaboration with internal and external stakeholders
• Strong problem-solving and negotiation skills within a regulatory context
• Excellent oral and written communication skills

Responsibilities

• Ensure successful completion of assigned audit engagements set forth in the company’s Audit Plan with the delegated entities
• Manage and carry out operational audit activities as assigned
• Apply audit & monitoring techniques to examine documentation, interview employees, and conduct analysis of data to identify deficiencies and best practices in controls and compliance with the Center for Medicare and Medicaid Services (“CMS”) requirements as well as any other relevant agency and organizational policies and procedures
• Identifying and managing potential risks associated with delegation of services, such as data breaches, compliance violations, or operational disruptions
• Manage the execution and documentation of all auditing and monitoring activities, according to the established annual work plan
• Ensure processes are followed in accordance with policies and procedures and regulatory guidance
• Perform analysis and trending compliance audits. Continuously evaluate specific audit/monitoring activities and determine if more formal or in-depth interventions are required
• Prepare clear and concise reports with the evaluations of risk, root cause, and scope of impact of the internal audit findings
• Performance Monitoring- tracking and evaluating the performance of delegated entities through regular reporting, audits, and reviews to ensure accountability and transparency
• Develop and implement audit tools based on regulatory protocols and guidance
• Work with areas to identify root cause and ensure any findings are corrected promptly and documented properly
• Perform follow-up monitoring as required to assess improvement on findings and ensure effectiveness of corrective actions resulting from previous audit/monitoring activities as well as issue management process
• Act as liaison between Clients and the Company for the coordination of external audits, facilitating a responsive and responsible audit process, including corrective actions, if applicable
• Keep up to date with regulatory requirements and best practices
• Create or review any policies and procedures or training, as needed
• Establish and manage communication and escalation methods
• Serve as liaison between Compliance and Abarca business units relating to all audits performed by client or regulatory agencies
• Coordinate with areas for reporting requirements or audit universe submissions, including gathering reports, performing quality assurance validations and final submission to clients

Benefits

Flexible hybrid work model