Internal Audit Specialist
Location: Milwaukee, Wisconsin US
Job Number: 1339
The Internal Audit Specialist is responsible for the end-to-end process of internal auditing of contracts, production, policies and procedures, and processes of a variety of internal business units. This is an additional compliance audit, over and above any internal business unit based audit. This role will also be responsible for audit completion, reporting, analyzing trends of audit data, performing root cause analysis, and recommending improvements within the department as well as within business units being audited.
PRIMARY JOB RESPONSIBILITIES:
- Performs routine and focus audits on a variety of business units to identify inaccuracies including, but not limited to, Enrollment, Customer Service, Claims, Utilization Management, Member/Provider Notification and Provider This is a second tier audit over and above any internal audits initiated by the business unit.
- Responsible for developing and completing audit tool for operational areas using the standards required in the contract. These may include specific accreditations or state/federal regulation.
- Required to interpret states and federal regulations as they pertain to the operational area being audited.
- Initiates and maintains internal business unit audits which will result in operational area Corrective Action Plan.
- Initiates and maintains internal business unit audits which are initiated as a result of a client issued Corrective Action Plan.
- Acts as primary contact for internal business unit subject matter experts for internal audit results.
- Reviews Customer Service calls as needed for client audits and Complaints and Grievance
- Reviews letters and templates for member notifications based on state requirements.
- Analyzes group and sub-group mappings as they flow down to production documents.
- Develops root cause analysis and develop action plans with operational area to address quality
- Provides quality feedback to business unit supervisors through error reporting
- Collaborates with other staff and leadership teams on the use of established business processes, procedures and related
- Recommends internal Corrective Action Plans, tracks activity through to closure and reports
- Creates strong, productive relationships with internal partners while maintaining a balance between contractual obligations, client expectations, and DentaQuest's interests.
- Demonstrates proficiency with the principles and methodologies of process
- Apply these in the execution of responsibilities in support of a process focused
- Coordinate relevant subject matter experts for working sessions related to internal process improvement initiatives for gaps identified as a result of the audit process.
- Develops new reports and audit tools as
- Ensures delivery and accuracy of monthly, quarterly, yearly and ad hoc internal audit
- Organize workflow throughout various departments to create improvements and efficiencies in the audit process.
- Performs other duties as assigned.
- Bachelor's degree in Business, Healthcare Administration (or related field) or 8 years of work experience.
- 2 years' healthcare experience (preferably in the dental space) or one year of experience in a Quality Assurance or Business Audit function or
- Proficient with general computer software including Microsoft Excel, Word and
- Exceptional communication skills and the ability to communicate appropriately at all levels of the organization with the ability to influence others to move toward consensus
- Excellent spirit for teamwork, problem-solving, communication, and decision-making
- Strong situational analysis and decision-making
- Excellent verbal, written, interpersonal, organizational and public speaking/communication
- Able to effectively communicate
- Ability to prioritize and organize multiple tasks with tight
- Ability to successfully manage multiple projects and priorities in a fast-paced, result-driven
- Attends additional training as requested/deemed necessary.
- Ability to work in a traditional professional office setting or remote equivalent.
- Ability to effectively operate computer equipment.
- Work schedule may vary and is determined by project schedules.
- Ability to efficiently operate all job-related office equipment.
- Ability to communicate via telephone and work in virtual teams
- The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.
Webelieve that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system - from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.
Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.
To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.
The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.
Job Number: 4189
Community / Marketing Title: Internal Audit Specialist
Location_formattedLocationLong: Milwaukee, Wisconsin US