Customer Solution Center Audit Readiness Specialist II

This position is responsible for the ongoing progression and maintenance of CSCs compliance program efforts including but not limited to policy and procedure development training and education initiatives and compliance programmatic developments and enhancements.

• Performs audit procedures for Customer Solution Center departments to ensure readiness; including identifying and defining issues developing criteria reviewing and analyzing evidence and documenting business unit processes and procedures.
  
• Conducts interviews reviews documents develops and administers surveys composes summary memos and prepares working papers. Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to Customer Solution Center management.
  
• Collaborates with business units in audit universe preparation and validation. Assists in document preparation for regulatory and internal audits.
  

• Works closely with Customer Solution Center Management to determine and handle effectiveness/accuracy of operational processes. Collaborates with internal Subject Matter Experts (SMEs) to understand Customer Solution Center regulatory processes and assists with getting to the root cause of identified deficiencies.
  
• Evaluates policies and procedures with applicable regulations/guidelines and provides recommendations to management for continuous process improvements.
  
• Collaborates with Customer Solution Center Business Analyst to track trend and analyze results of Quality Assurance (QA) scorecards for training and quality improvement.
  
• Perform other duties as assigned.
  
  

Requirements

• A minimum of 5 years of experience in regulatory auditing (Appeals & Grievances Call Center Enrollment) in a healthcare environment is required.
  
• Previous experience with MediCal and Medicare in a managed care environment.
  
• Advanced computer proficiency Word Excel; and Access is required.
  
• Strong analytical and team building skills.
  
• Ability to work effectively with diverse team members.
  
• Ability to formulate recommendations to improve quality and service delivery and develop effective system and process improvements.
  
• Ability to multitask and streamline daytoday operations.
  
• Ability to track and trend and create regulatory reporting.
  
• Strong interpersonal and organization skills and is expected to work independently within the departments established guidelines policies and procedures.