En Triple-S, estamos comprometidos con brindar experiencias laborales significativas para nuestra Gente Valiosa. Nos esforzamos por la excelencia en todo lo que hacemos, desde la forma en que trabajamos juntos hasta la forma en que servimos a nuestros clientes.
Al unirte a Triple-S, serás pieza clave para nuestros esfuerzos de brindar atención médica accesible y de alta calidad, así como también contribuirás a nuestro propósito de habilitar vidas saludables. Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia.
Construyamos comunidades saludables juntos. ¡Únete a nosotros!
JOB SUMMARY
ESSENTIAL FUNCTIONS
- Plan and develop the audit approach for assigned projects consistent with ASES, CMS state guidelines, DOL, PSG, Commercial and or MA policies and procedures and in accordance with the timeframes established by the management.
- Track PSG, Commercial and or MA lines of businesses open audit and monitoring issues and perform follow up to evaluate timeliness and adequacy of remediation efforts.
- Provide compliance performance feedback to internal business units under the PSG, Commercial and or MA lines of businesses.
- Produce high quality audit and monitoring reports for management, in compliance with PSG and Commercial lines of businesses policies and procedures; and in compliance with CMS regulatory requirements described in the Medicare Compliance Program Guidelines, Chapter 21 of the Medicare Managed Care manual and the Chapter 9 of the Medicare Prescription Drug Benefit manual and MA Line of Business policies and procedures.
- Monitor the MA, PSG and Commercial lines of businesses Compliance Company-wide monitoring tool, including but not limited to Compliance Dashboard or Compliance Scorecard.
- Conduct review of information provided by MA, PSG and Commercial lines of businesses internal departments for regulatory agencies oversight activities.
- Ensures the information is in compliance with the regulatory agencies requirements, identify and communicate to the management any associated risk. Responsible to manage, validate and submit MA Line of Business regulatory reporting requirements.
- Support and execute the communication, coordination, validation and submission of information regarding MA, PSG and Commercial lines of businesses Regulatory Agencies Oversight Activities. Supports the distribution of tasks through Compliance 360 and follow up on action items related to the MA, PSG and Commercial lines of businesses.
- Contributes in the reduction of year to year compliance issues related to the MA, PSG and Commercial lines of businesses.
- Communicate on a timely manner the identified non-compliance issues to the Compliance Audit and Monitoring Manager and the Compliance Officer related to the MA, PSG and Commercial lines of businesses.
EDUCATION
- Bachelor's Degree
Bachelor Degree with one (1) to three (3) years of experience as an auditor, planning and reporting research results. Knowledgeable in Data Validation audit, CMS audits & reporting requirements within healthcare industry is highly preferable.
LICENSES AND CERTIFICATIONS
- No requerido
COMPETENCIES
- Maneja la Ambigüedad
- Inspira confianza
- Colaboración
- Deleite al Cliente (Empleado)
- Orientado a la Acción
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