Provider Operations Audit Associate

, DataStaff, Inc is seeking a Provider Operations Audit Associate for a long-term contract opportunity with one of our direct clients located in Raleigh, NC •This role is hybrid; 1 day per week will be on-site

Job Description:

Provider Operations supports the administrative functions related to the enrollment, credentialing, and data maintenance of more than 117,000 NC Medicaid participating providers. Primary objectives of the Provider Operations Section are to oversee provider enrollment, manage contracts, coordinate the provider enrollment appeals processes, and organize legislative affairs. The Unit has a focus on internal capabilities, operational excellence, analytics and other process improvement functions, such as stakeholder relations and effective vendor management. In addition, Provider Operations assumes responsibility for an extensive amount of oversight and structured monitoring activities of the NC Medicaid Fiscal Agent, the Managed Care health plans and Primary Care Case Management programs.

Responsibilities:

Support audit and compliance monitoring activities of various departmental vendors Perform internal compliance audits to determine whether established protocols are being followed and/or where each can be improved. Utilize systems, monitoring tools, and business procedures to support internal controls and carry out assigned tasks. Assist with compiling data reports to reflect monitoring and oversight performance. Regularly review Provider Operations procedures, practices, and documents to identify and assess risks for monitoring deficiencies and audit findings. Professionally represent the agency and effectively communicate with internal and external partners. Perform other duties as assigned.

Skills:

Prefer education and/or experience in audit related field, government programs. Detail-oriented, excellent organizational skills, and ability to adhere to deadlines. Ability to establish and maintain effective working relationships with employees. Ability to express oneself clearly and concisely in oral and written form. Proven ability to interpret and apply complex Federal and State regulations and requirements. Demonstrated strong proficiency in Microsoft Excel, Outlook, Teams, and Word Ability to identify opportunities for process improvements, related to assigned duties, and perform in a manner which mitigates risk to the team. Excellent interpersonal and leadership skills, with an ability to communicate effectively across departments.

Expectations:

Job Knowledge:

Become a subject matter expert for all departmental systems and processes on an ongoing basis. Remain current in reading/studying/being familiar with policies and procedures, Medicaid bulletins, CMS notices, policies and other materials as relevant to Provider Operations as needed to fulfil responsibilities. Represent the Unit when necessary, regarding assigned backup duties. On an ongoing basis, assist with cross-training as required, evaluate ways to streamline duties, and improve processes to function effectively in the department.

Monitoring/Auditing:

Ensure integrity and prevent audit findings in NC Medicaid Provider enrollment by monitoring and evaluating Fiscal Agent activities in Provider Enrollment/Credentialing. Complete compliance monitoring activities as assigned and by due dates specified in policy. Document/Report findings and results on 100% of your monitoring activities each month. Discuss 100% of your monitoring findings/results during individual/team meetings with management. Initiate a discussion with management on items that need direction/attention of management. Assist with internal and external audit activities as assigned This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 months.

Pay:

$30.00 - $35.00 per hour

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Raleigh, NC 27603