Auditor

Title: Auditor
Job Category: Auditing
Location: New York City - Lower Manhattan, NY
Job Type: Regular
Req Number: heal-00001522

Description:
This position is responsible for measuring application processing accuracy, reviewing the applications, assembling and analyzing the audit results, initiating corrective action plans in response to the results, and communicating the results to management.

The incumbent will be knowledgeable CHP, FHP and Medicaid, regulatory mandates, and internal policies, and procedures.

At times, the Auditors will be required to participate as a team member in company initiatives and projects that may or may not have a direct relationship to the incumbent''s Specific Standards and Performance Goals.

Major Objectives for Incumbent and Team

' Audit enrollment applications received on a monthly basis for all product lines.
' Identify errors and tends in the enrollment process and conduct target audits to improve the overall quality and standards of the Enrollment Department.
' Maintain accurate and consistent records for errors found in the auditing process and communicate the findings to the Supervisors and Managers.
' Work closely with the Supervisors and Managers to monitor the inventory of applications and the number of applications that need to be audited.
' Partner with Supervisors and Managers to identify product or process knowledge that requires remediation.
' Understand and utilize performance key indicators to measure progress towards meeting enrollment standards and objectives for the Enrollment Representative and the Units.
' Know, understand, support, and enforce all Healthfirst policies and procedures to ensue that the department is in compliance and that department and individual actions support the overall organizational goals.
' Take the initiative to identify and make recommendations for ad hoc training sessions to meet the needs of the Enrollment Representatives.
' Assume leadership or supporting roles for ad hoc committees / teams, or problem resolution meetings.

Coaching and Counseling
' Conduct formal coaching, counseling, and training sessions for individual Enrollment Representatives as a result of the findings in the auditing process.
' Deliver auditing results in a professional and constructive manner and, when possible in a private location.

Mastery of Healthfirst''s Products, Policies and Procedures
' Know, understand, support, and enforce all of Healthfirst''s products, policies, and procedures to ensure that individual actions meet the overall organizational goals.
' Present, in a dynamic and authoritative manner, Healthfirst''s policies and procedures to Enrollment Representatives and members of management during feedback sessions.

Requirements:
' Minimum of 2 years product experience in the healthcare industry.
' Minimum of 2 years experience as an Enrollment Representative in at least one of the following products: Child Health Plus, Family Health Plus, Medicare, Medicaid, or HIV/SNP.
' Knowledge and experience with all products
' Excellent and effective oral communication skills
' Knowledge of regulatory policies and procedures and how these affect the enrollment and auditing processes
' Effective at initiating, developing, and maintaining professional relationships with the Enrollment Representatives, Supervisors, and Managers.
' Ability to be a role model for Enrollment Representatives by personifying excellent work ethics and demeanor. Willing to work alongside associates and stay extra hours during peak or critical times.
' Skilled at problem solving, prioritization, and conflict resolution.
' Flexibility and ability to adapt to a changing work environment, and accept change in direction and / or goals quickly/ effectively.
' Ability to handle confidential information with absolute discretion.
' Effective computer skills, systems knowledge, and desktop navigation.

Education:
' High School diploma or equivalent required.
' College degree or 2 years of relevant experience

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