Fallon Health

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Internal Auditor I

Internal Auditor I

Job ID 
4945
# Positions 
1
Location 
US-MA-Worcester
Posted Date 
11/1/2017
Category 
Internal Audit

More information about this job

Overview

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.

 

Brief Summary of position:

Under the direction of the Audit Director or Senior Auditor, the Internal Auditor I will execute on the following:

  • Assist management on audits, projects, as well as special requests.
  • Independently plan, design, perform all aspects of audits following departmental standards and procedures, including walkthrough of processes, setting objectives, defining scope, designing tests and performing the audit testing.
  • Perform risk assessments, including identification, evaluation, and documentation of business risks and controls.
  • Analyze audit evidence to provide management with an evaluation of the adequacy of financial and operational controls and make recommendations for improvement.
  • Communicate effectively with all levels of management to ensure full understanding of objectives, risks, controls, and observations.
  • Prepare clear and concise draft audit reports and other communications.
  • Complete ad hoc projects as requested by management.
  • Support the Model Audit Rule (MAR) internal control attestation and regulatory (Center for Medicare and Medicaid Services (CMS)) compliance testing.
  • Support fraud investigations as requested by management.
  • Conduct audits of claims payment for accuracy and compliance with existing policies and contracts. Work with internal department and external providers to correct system problems and recover overpayments.

 

Responsibilities

 

  • The primary focus of this role will be to assist management on audits, projects, as well as special requests; independently plan, design, perform all aspects of audits following departmental standards and procedures, including walkthrough of processes, setting objectives, defining scope, designing tests and performing the audit testing.
  • Assisting other auditors with internal audit testing or working on less complex engagements independently.
  • Identify control gaps within internal controls, communicate findings to process owners, and make recommendations for remediation.
  • As time and necessity allow, become involved in internal control projects and fraud investigations.
  • Provide updates to the Director of Internal Audit regarding progress.
  • Support the Director of Internal Audit in implementing the annual audit plan.

Qualifications

Education:

Bachelor’s degree is required, preferably in Business Administration or Accounting.

 

License/Certifications:

Other Professional certification (CPA or CIA), or master’s degree a plus.

 

Experience:

  • 1 to 3 years of relevant work experience can be experience working in corporate environment, preferably in health care environment and/or internal audit experience.
  • Model Audit Rule / Sarbanes-Oxley Act (SOX) testing preferred, but not a requirement.
  • 3-5 years coding experience strongly preferred
  • Effective oral and written communications.

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