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Medicare Audit Senior Consultant

Primary Location: Hartford, Connecticut
Additional Locations: CT-Hartford
The Audit Senior Consultant coordinates and supports
organizational compliance with National Network Delegation policies and
process, evaluates the performance of risk and/or delegated provider
relationships, identifies compliance issues and closes performance gaps.
Performs Medicare assessments of delegates to verify compliance with Aetna
standards and regulatory requirements by utilizing the prescribed due
diligence, contracting, and reporting tools.

Fundamental Components:

Support the effectiveness of delegation risk management and
oversight processes, control and governance processes, and add value to our
business partners & overall operations. Participate in the execution of
complex procedures and tasks for assigned compliance objectives and process
improvement initiatives. Ensure successful completion of assigned audit
activities, from start to finish, inclusive of preplanning and wrap up
activities. Performs, in accordance with state, federal, accreditation, and
Aetna delegation/oversight standards, audit activities to verify and monitor
compliance with regulatory requirements and standards, including: reviews
documentation obtained during outreach efforts to the delegate for assigned
audit activities, identifies and communicates issues raised and offers
recommended solutions to mitigate risk, actively participate in communication
to clarify status, follow-up items, and corrective action plans. With little
to no guidance, obtains and reviews evidence ensuring audit results and work
papers are clear, concise, well-documented, and retained. Provides audit
results and supporting documentation to senior project manager for review and
approval prior to release. Conducts audit activity follow-up and monitoring.
Participates and presents at required delegation oversight committees.
Assists with supporting and educating network staff in their understanding of
delegation requirements and the oversight processes to comply with the
regulatory requirements. Ensures adequate focus on personal professional
growth relevant to taking on more challenging assignments, in line with
career progression. Supports and/or manage special projects as needed.

Background Experience:
Problem Solver Able to work independently and
motivated to achieve department goals. Able to work in a fast pace, deadline
driven environment. Past experience includes any/all of the following:
auditing, quality assurance, compliance, and Medicare Minimum of 2-4 years of
Audit, Compliance, or related business experience. Advanced skill level with MS
Excel, Word and Outlook. Proficient skill level with MS Visio and MS Access is
preferred Able to travel up to 20%.

Additional Job Information:
Join a growing team with numerous opportunities to
grow and develop. Support the expansion of our Medicare Delegation Oversight
program. Ability to collaborate with and learn from SME's in areas such as
Medicare Compliance, Legal, and Network. Strengthen written and verbal communication
skills through delivery of reports and participation in Committees/meetings.
Develop and utilize ABX Six Sigma/Lean skills as we rebuild the framework,
processes, and controls for this organization. Learn to assess the risk of the
delegate population, analyze data and trends, and manage delegate compliance
with standards and regulatory requirements.

Required Skills:
General Business - Applying Reasoned Judgment, Leadership - Driving a Culture of Compliance, Technology - Selecting and Applying Technology Solutions

Desired Skills:
General Business - Communicating for Impact, Leadership - Creating Accountability, Leadership - Developing and Executing Strategy

Functional Skills:
Communication - Communication Delivery - Public Speaking, General Management - Data analysis & interpretation, General Management - Project management (non-IT), Management - Management - Process and quality improvement, Project Management - Time Management

Technology Experience:
Database - Microsoft Access, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Visio, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)


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