The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Under the direction of the Compliance Officer and Compliance Department management, the Compliance Auditor is responsible for working independently on assigned projects to ensure health plan compliance with Medicare (Part C and D), NYS Medicaid and MLTC regulations. Initiates and perform audits and monitoring activities of various health plan operations, such as appeals and grievances, claims, medical management, customer service, provider relations and contracting, sales and enrollment, and other functions to ensure proper compliance with governmental regulations and health plan policies.

• Bachelor's Degree required.
• Three or more years of experience in auditing required.
• Experience in compliance, healthcare, and Medicare and Medicaid managed care is helpful and preferred.
• Additionally, experience in facilitating regulatory audits, such as CMS, DOH and DFS audits is helpful and preferred.
• Ability to independently conduct audits;
• Ability to develop and implement audit plans, protocols, corrective action plans, root cause analyses, and impact reports;
• Ability to interact with all levels of management, as well as federal and state regulatory agencies;
• Excellent verbal and written communication skills essential;
• Proficiency in Excel and experience in data analysis, charting, and dashboards.