Principal Revenue Audit and Quality Assurance

Exemption Status:

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Summary: 

Under general direction of the Vice President of Risk Advisory & Internal Audit, this position is responsible for developing and leading programs to improve MedImpact & Subsidiaries (MI) Revenue Cycle and related processes.  Responsible for providing audit and quality assurance (QA) services to MI management and coordinating and supervising audit & quality assurance resources. Develops, fosters and maintains positive relationships with management across the organization and proactively consults with managers to correct deficiencies with internal controls.

Essential Duties and Responsibilities:

• Develops and leads MI & Subsidiary Revenue Cycle internal control program. Works with management to identify and document key Revenue Cycle processes and controls. Develops a quality assurance program to assess the effectiveness of Revenue Cycle controls. Identifies root causes for internal control breakdowns and makes recommendations to accountable process and controls owners on improvement opportunities.
• Develops and leads program to provide oversight of client billing and warranty payouts. Works with the Client Financial Resolution committee, Account Management and Finance leadership to provide validation that the payout root cause analysis was adequately performed and process defects leading to the payouts was effectively remediated.

• Manages the audit & quality assurance staff and ensures that Revenue Cycle audits and projects are properly planned and completed per expected timeline and budgeted hours.  Ensures that adequate supporting documentation exists to support audit findings. Evaluates staff on engagement performance.

• Prepares accurate and timely written reports; makes oral presentations to management on findings, recommendations. Also performs follow up reporting and status of previously identified issues related to the Revenue Cycle.

• Act as liaison with business stakeholders by identifying key Revenue Cycle risks affecting the organization, consulting on countermeasures to mitigate risks and promoting the sharing of best practices across the organization.

• Coordinates with external auditors the review of all Revenue Cycle walkthroughs and other process documentation, control testing, evaluation of control deficiencies and coordination with external auditors

• Understands the financial, operational, compliance and other risks which affect the organization. Assists the Vice President in the development of the organizational risk assessment and audit project work plan

Supervisory Responsibilities        

Manages assigned Revenue audit & QA staff and carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Supports and enforces all company policies and procedures in a fair and consistent manner, taking corrective action whenever necessary.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service and interpersonal communication skills. (listening/verbal/written).  One must be able to: respond promptly to client needs; solicit client feedback to improve service; respond to requests for service and assistance from clients; meet commitments to clients; and manage difficult client situations.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience                   

Bachelor degree or higher in Business / Finance or related field

10 years of professional auditing experience

Pharmacy Benefit Manager, Pharmaceutical, Healthcare industry experience preferred

Computer Skills

• Strong proficiency with MS Office required -  Word, Excel, PowerPoint and Outlook
• Basic knowledge of flowcharting software - Microsoft Visio, IBM Blueworks
• Data analytical software skills experience helpful.  - ACL, IDEA, Tableau
• Strong aptitude to learn and adapt to new programs and applications

Certificates, Licenses, Registrations

Certified Internal Auditor (CIA) or Certified Informational Systems Auditor (CISA) or Certified Public Accountant (CPA)

Other Skills and Abilities                                                    

• Working knowledge of Generally Accepted Auditing Standards (GAAS), Generally Accepted Accounting Principles (GAAP) Sarbanes Oxley (SOX), and Committee of Sponsoring Organizations (COSO) risk frameworks.
• Knowledge of federal/state healthcare compliance regulations (CMS, OIG, OCR, HIPAA,) desirable
• Excellent project management and communication skills
• Excellent and insightful analytical skills and business acumen

Working Hours

This is an exempt level position requiring one to work the hours needed to get the job done.  Therefore one must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required.  This may be changed from time to time to meet the needs of the business.  Typical core business hours are Monday through Friday from 8:00 am to 5:00 pm.

Travel

This position requires both domestic and international travel of up to 20% of the time.  A valid passport and ability to leave the United States is required

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.