Provider Operations Audit Associate

DataStaff, Inc is seeking a Provider Operations Audit Associate for a long-term contract opportunity with one of our direct clients located in Raleigh, NC

*This role is hybrid; 1 day per week will be on-site

Job Description

:Provider Operations supports the administrative functions related to the enrollment, credentialing, and data maintenance of more than 117,000 NC Medicaid participating providers. Primary objectives of the Provider Operations Section are to oversee provider enrollment, manage contracts, coordinate the provider enrollment appeals processes, and organize legislative affairs. The Unit has a focus on internal capabilities, operational excellence, analytics and other process improvement functions, such as stakeholder relations and effective vendor management. In addition, Provider Operations assumes responsibility for an extensive amount of oversight and structured monitoring activities of the NC Medicaid Fiscal Agent, the Managed Care health plans and Primary Care Case Management programs

.
Responsibilities

• : Support audit and compliance monitoring activities of various departmental vendo
• rsPerform internal compliance audits to determine whether established protocols are being followed and/or where each can be improve
• d.Utilize systems, monitoring tools, and business procedures to support internal controls and carry out assigned task
• s.Assist with compiling data reports to reflect monitoring and oversight performanc
• e.Regularly review Provider Operations procedures, practices, and documents to identify and assess risks for monitoring deficiencies and audit finding
• s.Professionally represent the agency and effectively communicate with internal and external partner
• s.Perform other duties as assigne

d.
Skil

• ls:Prefer education and/or experience in audit related field, government progra
• ms.Detail-oriented, excellent organizational skills, and ability to adhere to deadlin
• es.Ability to establish and maintain effective working relationships with employe
• es.Ability to express oneself clearly and concisely in oral and written fo
• rm.Proven ability to interpret and apply complex Federal and State regulations and requiremen
• ts.Demonstrated strong proficiency in Microsoft Excel, Outlook, Teams, and W
• ordAbility to identify opportunities for process improvements, related to assigned duties and perform in a manner which mitigates risk to te
• am.Excellent interpersonal and leadership skills, with an ability to communicate effectively across departmen

ts.
Expectati

ons:Job Knowle

• dge:Become a subject matter expert for all departmental systems and processes on an ongoing ba
• sis.Remain current in reading/studying/being familiar with policies and procedures, Medicaid bulletins, CMS notices, policies and other materials as relevant to Provider Operations as needed to fulfil responsibilit
• ies.Represent the Unit when necessary, regarding assigned backup dut
• ies.On an ongoing basis, assist with cross-training as required, evaluate ways to streamline duties and improve processes to function effectively in the departm

ent.Monitoring/Audit

• ing:Ensure integrity and prevent audit findings in NC Medicaid Provider enrollment by monitoring and evaluating Fiscal Agent activities in Provider Enrollment/Credential
• ing.Complete compliance monitoring activities as assigned and by due dates specified in pol
• icy.Document/Report findings and results on 100% of your monitoring activities each mo
• nth.Discuss 100% of your monitoring findings/results during individual/team meetings with management. Initiate a discussion with management on items that need direction/attention of managem
• ent.Assist with internal and external audit activities as assi

gned
This opportunity is available as a W2 position with a competitive benefits package. DataStaff, Inc. offers medical, dental, and vision coverage options as well as paid vacation, sick, and holiday leave. As many of our opportunities are long-term, we also have a 401k program available for employees after 6 mo