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Posted: Friday, June 2, 2017 12:03 AM


The position reports to the Compliance Audit Manager and provides support for the audit activities assigned. The position supports the Audit Senior Manager in his/her leadership of the functional area of business they audit and is responsible for the efficient and timely delivery of all audit activities related to the function line of business which he/she supports as well as department strategic initiatives.

The Senior (Compliance) Auditor will conduct regulatory audits activities to evaluate compliance with the federal and state regulations, including our Centers of Medicare and Medicaid Services (CMS) Medicare Advantage (MA) and Medicare and Medicaid Program (MMP) programs, as well as our First Tier, Downstream, and Related Entities (FDRs). The Senior (Compliance) Auditor will require considerable knowledge of the business operations and the policy requirements associated with them, including the Code of Federal Regulations, Medicare Managed Care Manuals, and the State Medicaid Manuals.

* Supports the Auditor-In-Charge across all phases of the audit (i.e. Planning, Fieldwork, Reporting) to ensure audits are completed timely, with quality, and according to department guidelines, methodology, and approach.
* Supports development of and performs auditing procedures that provide for the evaluation of the system of internal controls adopted within the business.
* Works collaboratively with team, business and operational areas to perform audit activities assigned and develops remediation plans for issues identified.
* Communicates results of audit activities with audit management and facilitates the development of management action plans to address any deficiencies identified.
* Responsible for completing all performance and development objectives set forth annually.
* Supports external auditor as need to support external requests.
* Supports Management request regarding the internal control environment, and in carrying out investigations of alleged financial mismanagement, loss of assets, or other irregularities as needed.
* Performs other duties and or special projects as assigned or required.

* Business
o Industry & Organization Knowledge
o Products & Services

* Individual
o Analytical & Critical Thinking Skills
o Teamwork
o Interpersonal Relationship
o Accuracy & Attention to Detail
o Written & Oral Communications
o Presentation
* Technical Skills
o Audit/Risk Assessment
o Business Process Analysis
o Project Management

Job Requirements

(Minimum education & certifications required)
* Bachelor's degree, advanced degree preferred

Minimum of 3-5 years' experience of audit, regulatory compliance or a related field, including quality assurance or internal control areas. Previous experience in the traditional Medicare, Medicare Advantage, or State regulatory environment is strongly preferred. ?

Certified Internal Auditor (CIA) designation, strongly preferred?

Certified in Healthcare Compliance (CHC), strongly preferred

EXPERIENCE: (Years of experience)
* Healthcare Industry Experience; Preferably Healthcare Insurance experience.
* Knowledge of the operation, procedures and policies of assigned business units. Strong familiarity with their specific business processes and transactions
* Knowledge of Generally Accepted Audit Standards, IIA standards, accounting and auditing sampling and testing methodologies, risk management and statutory reporting
* Knowledgeable and experienced in benchmarking and process improvements

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Email Address:

• Location: Boston, Watertown

• Post ID: 39219093 massachusetts is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017