The Internal Auditor I completes independent, objective internal audits designed to determine the adequacy of internal controls, and test and confirm compliance with applicable requirements. Primary duties of the Internal Auditor I include conducting audits of Alliance’s Care Management program, other managed care functions, and delegation audits, noting strengths and identifying opportunities for improvements. As such, the Auditor I must have an in-depth understanding of managed care processes and systems.

This position will allow the successful candidate to work a schedule which will include both onsite as well as remote work certain days of the week as approved by their supervisor. The selected candidate must reside in North Carolina.

Responsibilities & Duties

Auditing

• Follow defined audit methodology, taking the initiative to continually improve execution and make improvement recommendations.
• Execute audit activities and construct draft deliverables in a way that contemplates executive interest and reactions to observations; seek coaching and information to develop an understanding of audit committee viewpoints and expectations.
• Design and review audit work programs, testing strategies, and detailed testing procedures.
• Evaluate the adequacy, effectiveness, and efficiency of the systems of internal control.
• Review audit responses and action plans developed by the auditee/management.
• Conduct periodic audit follow-up reviews to assess and report on progress or completion of management’s corrective action.
• Conduct audits of delegated entities (e.g. pre-delegation and annual delegation audits).

Risk Management

• Assist in the annual system-wide Enterprise Risk Management risk assessment cycle
• Conduct internal audit initiatives, special projects, and improvement initiatives.

Communication & Relationship Management

• Build relationships with key constituents and serve as a resource of professional advice, as appropriate.
• Manage external relationships (e.g. external auditors, regulators and consultants).
• Represent internal audit’s goals, objectives, and viewpoints in collaborating with management and business constituents.
• Effectively communicate with other internal audit staff, Director of Internal Audit, and Alliance management. 
• Work closely with department leadership to ensure consistent and accurate processes and alignment with all Federal and State requirements.

Investigations

• Conduct interviews with current/former employees, recipients of services, and other witnesses.
• Review allegations and makes recommendations for audits, investigations, or referrals to other Alliance departments.
• Systematically and accurately collect evidence.
• Track audit and investigation activities in a centralized system (currently SAI Global/C360), from initial assignment to final disposition

Knowledge, Skills, & Abilities

• Knowledge of best practice investigative and internal audit protocols, including interviewing, gathering evidence, etc.
• Knowledge of risk, fraud or health law.
• Knowledge of state and federal Medicaid laws, administrative rules, state policies, and other guidelines
• A general understanding of all major MCO functions, particularly as it relates to Care Management, grievance management, internal monitoring requirements.
• Knowledge of investigative techniques and methods, such as interviewing, gathering evidence, etc
• Knowledge and understanding of computerized tracking systems and databases
• Ability to analyze and understand regulatory requirements, and apply pertinent imperatives to business functions when developing and conducting audits or investigations.
• Excellent analytical, decision-making, and time management skills.
• Intermediate computer skills in Microsoft Office (e.g. Word, Excel)
• Ability to interpret contractual agreements and other business documents
• Ability to maintain confidentiality and handle highly sensitive information with discretion
• Ability to evaluate clinical and administrative records for completeness and compliance.
• Ability to communicate professionally and succinctly with various stakeholders
• Ability to analyze financial data and identify concerning trends, patterns, and other risks
• Ability to mine and analyze large amounts of data and generate effective reports

Minimum Requirements

Bachelor’s degree in accounting, business administration, a mental health field, or other appropriate area from an accredited college or university and at least three (3) years of progressive compliance/regulatory auditing experience, preferably in a healthcare environment. Managed care, Care Coordination or Care Management experience is strongly preferred.

Certification in one of the following is strongly preferred:

Certified Internal Auditor (CIA) 

Certified Public Accountant (CPA) 

Certified Fraud Examiner (CFE) 

Certified in Healthcare Compliance (CHC) 

Accredited Healthcare Fraud Investigator (AHFI) 

Certification in Risk Management Assurance (CRMA) 

Certified Information Systems Auditor (CISA) 

Certified Financial Analyst (CFA) 

Certified Management Accountant (CMA) 

Certified Financial Services Auditor (CFSA)

Salary Range

$62,100 -$103,500/ Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes: 

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility