Director, Regulatory Audit

Full Time
Main Location
New York City, NY, United States
Jobs
The Director, Regulatory Audit reports to the Vice President, Regulatory and works with other Regulatory personnel and members of management. The Director, Regulatory Audit is responsible for providing oversight and support for all Healthfirst responses to external auditors and other state and federal regulatory agencies. The Director, Regulatory Audit is the primary liaison between Healthfirst and auditors and examiners acting on behalf of a regulatory agency for any and all lines of business (LOBs).

Duties & Responsibilities:

  • Maintain direct management of the Regulatory Audit team responsible for the oversight and support of all regulatory audits, surveys, and other related requests
  • Attend various audit meetings including entrance conferences, status meetings, and exit conferences on behalf of the enterprise
  • Manage all activities associated with external audits; serves as main point of contact between auditors and Healthfirst leadership
  • Manage projects assigned to the Regulatory Audit team to ensure timely and effective implementation
  • Oversee, analyze and review prepared responses to audit reports; address recommended corrections as needed
  • Maintain and revise all departmental policies and procedures related to external audits
  • Partner with the Compliance Department to monitor compliance with Corrective Action Plans (CAP) subject to regulatory examination, including actions taken on findings reports, and any ad hoc internal regulatory CAPs resulting from prior monitoring
  • Partner with leadership across the enterprise to assess audit risk for upcoming regulatory audits and advise on how to respond to questions related to the operational areas subject to direct review by regulators
  • Serves as subject matter expert on external regulatory audit matters; answers questions from internal departments about various topics and participates on teams that are involved with external audit preparation 
  • Identifies and presents issues that may impact the business to the attention of the appropriate business leaders
  • Continually monitors and improves external audit processes to ensure that the organization, as well as outside vendors, are compliant with applicable laws
  • Work with leadership to develop corrective actions for effective and efficient implementation of audit recommendations; communicate and track progress of corrective actions on behalf of leadership
  • Provide audit status updates to executive management
  • Assist leadership with the implementation of internal control and regulatory process improvements
  • Prepare written summaries for the Vice President for inclusion in various board reports and/or all applicable committees.

Minimum Qualifications:

  • Prior experience leading and managing regulatory audits with such agencies as CMS, DFS, DOH, IPRO, OMIG, OSC, and other regulatory bodies
  • Prior experience leading, conducting or facilitating audits at one or more of the following: commercial health insurer, Medicare Advantage, or Medicaid Managed Care organization
  • Bachelor’s degree from an accredited institution with a concentration in Finance, Business Management, or a Health Management related field
  • Experience with coordinating regulatory-based financial audits pertaining to New York insurance law and regulation, including familiarity with HCRA audits and Covered Lives Assessment audits

Preferred Qualifications:

  • Proven critical thinking, analysis and problem solving skills
  • Good judgement
  • Strong oral and written communication and presentation skills
  • Flexible, creative and adaptable in dealing with problems
  • Certification in health care compliance
  • Demonstrated ability to drilldown to fully analyze an audit challenge and determine appropriate programs and initiatives in response to results

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.


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Director, Regulatory Audit
Healthfirst, Inc.