JOB SUMMARY: Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) Provider operations departments. Collaborates with other Health plan departments and Management to ensure documents are managed in accordance with Federal, State and CPHL established guidelines and/or policies and procedures. Provides feedback or suggestions to enhance current processes and/or systems; works under general supervision. PRIMARY RESPONSIBILITIES: Follow defined audit processes and keep up to date with departmental changes in conducting quality reviews. Plan and execute an objective monitoring and internal audit to improve the organization's operations. Summarize audit results and findings in a constructive manner - presenting and discussing audit findings with management and employees Identify and Investigate inconsistencies, regulatory requirements and best practices and initiates the development of a structure or solution to address the issue(s). Coordinate with the subject matter expert to keep process documentation updated Maintain good working relationships within and outside of the department. Other duties and responsibilities as assigned. EDUCATION AND EXPERIENCE: Education Required: Associate degree or equivalent work experience. Preferred: Bachelor degree Type of Experience Required: Good computer literacy Good time management skills Ability to work independently and self-sufficiently on assigned tasks. Strong work ethic, attention to detail and highly organized. Preferred: Relevant experience in audit or compliance practices. Strong critical thinking skills, including the ability to assimilate new information, make sound decisions, plan ahead and manage multiple tasks Specific Technical Skills Preferred: Proficiency with MS applications, including but not limited to Word, Excel, Outlook, Power Point, Database Management Documentation Certifications/Licensure: Required: n/a Knowledge and Skills: Excellent attention to detail and the ability to prioritize and work on multiple projects in a fast-paced, changing environment. Effective presentation skills Excellent verbal and written communication skills Dependable team member who can take direction easily and work autonomously. Preferred: Proactive, results-focused operating style with effective communication, time and relationship management, and collaboration skills SCOPE INFORMATION # Direct Reports: PHYSICAL REQUIREMENTS: The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Able to operate computer equipment Able to communicate by phone The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.