Job Description

The Part C and D Auditor position is responsible for performing internal audits and monitoring activities related to Part C and D operations for Leon Health’s Medicare Advantage Prescription Drug Plan (MAPD) and Dual-Special Needs Plan (DSNP). The Auditor is also responsible for reporting audit results to management and operational area business leaders and assisting with the development of remediation plans, as necessary. The Part C and D Auditor stays current with regulatory requirements and uses critical thinking and sound judgement to manage guidance interpretation requests across the organization.

Key Responsibilities

  • Maintains knowledge of Federal and State laws, regulations
  • Performs and tracks internal and First-Tier, Downstream, and Related Entities (FDR) audit and monitoring activities to ensure compliance with company policies, contracts, and regulatory guidelines
  • Supports identification of issues, gaps, and risks
  • Reports results of auditing and monitoring activities in a timely manner and assists with the development of remediation plans, as necessary
  • Tracks development and implementation of remediation plans
  • Assists with external regulators audits
  • Assists in development of audit and monitoring tools
  • Provides Business support on Medicare Compliance matters
  • Develops strong relationships with key leaders to identify and address compliance risks and issues
  • Interacts with external federal, and state regulators, vendors, and internal stakeholders, as necessary