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Job Posting Title

Regulatory Audit Specialist Sr. - Remote

Job Description

The Regulatory Audit Specialist Sr is accountable for managing regulatory and/or client-initiated audits, by evaluating and understanding the purpose of various audit types and the related deliverables. As a process/subject matter expert supporting the navigation of the end-to-end audit process, this role pursues and obtains additional expertise as indicated from respective Compliance and operational subject matter experts to meet the applicable regulatory, client, and/or functional audit expectations. The Regulatory Audit Specialist Sr provides consultation and strategic advice regarding audit management practices to business partners and external parties.

Responsibilities

Assess audit processes and documentation and maintain thorough and accurate documentation, consult on initiatives to improve processes to meet evolving regulator needs

Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request.

Present sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implications

Develop and maintain key internal and external relationships to effectively provide audit management consultation regarding the streamlining of work activity, creation of efficiencies, and promoting consistent, timely and accurate completion, reporting, or submission of audit deliverables

Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings

Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes

Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders.

Demonstrate high-level project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, from the point of audit intake through the entire audit

Support department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained

Accountable for ongoing external facing relationships as established for the purposes of audit activities; ensure consultative and collaborative interactions with stakeholders in working through the audit response process

Monitor and escalate associated issues and risks to the appropriate governing body and drive development and refinement of business processes and identification of best practices to ensure the most effective and efficient processes and operations are put into place to decrease risk for repeat audit findings

Perform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirements.

Other duties as assigned

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Minimum Qualifications

Bachelor’s degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

5 years of relevant work experience in compliance, operations, or audit within a regulated environment

Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

Strong verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings

Excellent interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities

Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy

Strong organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality

Agility and adaptability to change and navigate in a dynamic, fast-paced, intense, and matrix environment

Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence

Advanced proficiency in Microsoft Office Suite (Word, Excel, Power Point, Visio and Access)

Ability to quickly learn new tools and technology and strong demonstrated experience in working with the Microsoft Office Suite

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Preferred Qualifications

Health insurance/PBM operations and/or regulatory compliance audit experience

Project management experience

Experience working as liaison with state governmental agencies

Certification or licensure in a related area of expertise (e.g., Pharmacy Technician, CAPM/PMP,CCEP or HCCA certification)

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Minimum Physical Job Requirements

Minimal travel may be required

Ability to work a flexible schedule outside of Prime’s core business hours to occasionally accommodate different time zones and during critical client audits

Constantly required to sit, use hands to handle or feel, talk and hear

Frequently required to reach with hands and arms

Occasionally required to stand, walk and stoop, kneel, and crouch

Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

Reports to a Manager in the Legal departmentPotential pay for this position ranges from $74,000.00 - $118,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].