Medicare Compliance Auditor – Clinical- Work at home
Virtual US
Remote, work at home, United States
Medicare Compliance Auditor (Band 4 – Advisor)
The Medicare Compliance Auditor is responsible for auditing the compliance with regulatory requirements and standards relative to the Medicare Parts C and D Program, with a particular focus on areas requiring clinical expertise. This individual is responsible for conducting audits in such a way that ensure (i) that all Medicare regulatory requirements and standards are understood, (ii) business processes required to address those regulations and standards are implemented and (iii) any compliance risks are communicated to the Compliance Officer. The Compliance Auditor may also help with the facilitation and project management of external regulatory audits such as the CMS 1/3rd Financial Audit and CMS Program Audits.
The Compliance Auditor must be able to effectively communicate with all levels of management (including senior leadership) as well as external regulatory auditors. This role requires an assertive, flexible individual with the ability to create structure in potentially ambiguous situations. This individual must maintain open lines of communications with the business and must promote Cigna’s enterprise-wide culture of compliance.
Responsibilities
- Conduct high quality compliance audits which support Cigna compliance with Medicare rules and regulations;
- Conduct internal mock CMS Program Audits related to SNP-MOC and ODAG clinical decision making;
- Facilitate and manage external CMS regulatory audits of Cigna;
- Validate that Medicare regulations have been implemented correctly by Cigna;
- Maintain good working relationships with internal parties to ensure open lines of communications and timely responses to compliance questions;
- Create a sense of urgency with internal business partners to achieve objectives; and
- Remain aware of industry compliance changes and/or trends.
Qualifications
- 3+ years of leadership managing projects;
- Strong knowledge of Medicare and Medicaid regulations
- clinical background required, RN or LPN preferred.
- Prior audit experience (compliance audit, internal audit and/or financial audit); Needed
- Excellent attention to detail and analytic skills required;
- Strong problem solving skills required;
- Superior and confident oral and written communication skills required;
- Ability to work collaboratively with others required (and influence colleagues, when appropriate, in their decision-making process);
- Prior coordination among remote teams preferred
For this position, we anticipate offering an annual salary of $82,400 – $137,300, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our careersite: www.cigna.com/careers
About Cigna
Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.