Massachusetts Jobs

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Job Posting Title

Audit Coordinator Lead - Remote

Job Description

The Audit Coordinator Lead has business unit responsibility for the management of all external audit activities and associated client facing efforts. This role serves as Prime’s primary external client liaison and internal business leader by understanding, planning, coordinating and leading audit support across all levels of the organization for assigned business unit.

Responsibilities

• Act as Prime’s primary contact and lead for external audit and Client monitoring efforts for all Prime clients in assigned business unit

• Represent assigned processes as a subject matter expert in business requirements, system specification, process flows, process change, Federal and/or State/Accreditation regulations

• Accountable for the cross functional leadership, coordination, facilitation and delivery of assigned business unit external audits from initiation through closure; for both internal and client needs, this includes scope definition, requirements development, issue resolution/risk mitigation, and business and IT deliverables

• Establish, maintain and build ongoing client relationships and relationships with leadership of other functional areas and internal stakeholders

• Facilitate, coordinate and provide prompt resolution for any client needs that may include: communicate business changes, procedural updates, missed turnaround times per Federal and State regulations, regulatory/guidance changes and other client specific needs as requested

• Facilitate, coordinate and complete Corrective Action Plans requested by clients, CMS, accreditation and internal compliance areas by communicating and driving with internal business areas

• Support internal business areas with contingency efforts as well as driving process changes with regards to CMS, state guidance, and accreditation to ensure compliance

• Facilitate, lead, assess and create CMS audit protocol universe reports and client monitoring reporting efforts to clients on a regular basis per client requests

• Collaborate with, provide work direction to, and train and mentor Audit Coordinators

• Other duties as assigned

Required Minimum Qualifications

• Bachelor’s degree in Business, Accounting, Finance, Health 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 work experience in audit or compliance, in healthcare, PBM or other highly regulated industry

• 1 year of experience leading cross functional work efforts and overseeing compilation of documentation

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

Additional Qualifications

• Knowledge of, or experience with state, federal and accreditation PBM rules and regulations

• Proficiency in Microsoft Office Suite and relevant business unit systems (e.g. RxClaims in Clinical Operations)

• Ability to meet tight time frames and work under pressure

• Ability to work in a collaborative team based environment

• Demonstrated excellent written, verbal and listening communication skills

• Client-facing exposure and/or experience

• Adept at interpreting complex information and communicating it effectively with appropriate end users

• Ability to multi-task and be flexible with changing business expectations

• Strong interpersonal communication skills including facilitation, negotiation and conflict resolution

Preferred Qualifications

• Knowledge of, or experience with Medicare Part D, Medicaid, Commercial or HIM lines of business

• Experience related to, or within Pharmacy Benefit Management (PBM)

• Significant account management or project management experience

• Background with SOC/SOX experience

• Experience with risk and controls

Minimum Physical Job Requirements

• 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 Supervisor, Manager, or Director in the Clinical Operations, Supply Chain, Contact Center or PBM Operations department

Potential pay for this position ranges from $74,500.00 - $111,700.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

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 an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ​ 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 Careers@primetherapeutics.com.