Government Programs Audit Coordinator
Job Type
Full-time
Description

Come Smile with Us!


Delta Dental of Iowa invites candidates for Government Programs Audit Coordinator to plan and execute internal and external audit activities specifically related to Iowa Medicaid and Medicare Advantage contracts. In collaboration with internal teams, you will collect evidence, report to external partners, and organize responsive and comprehensive replies. You will also coordinate requirements for corrective action plans and provide internal training and guidance on Medicaid and Medicare audit matters. This is an opportunity to serve as coordinator for Medicaid Single Case Agreements (SCA).


Why Delta Dental? We provide dental and vision insurance to more than 1.5 million Iowans. As a not-for-profit insurance company, our mission is to improve the health and smiles of the people we serve. We give back to Iowa communities by investing in health and wellness initiatives that make a measurable difference in the overall health of Iowans. Come see why we are passionate about "Bringing Smiles" to our customers. Our team enjoys competitive pay and benefits, an awesome "One Team" approach, and a company culture that fosters "Exceptional Quality Service" and "Leadership at All Levels." Love where you work!   


Essential Functions and Principal Accountabilities: 

  • Manage audits related to the Iowa Medicaid contract and Medicare Advantage Contracts. Arrange logistics such as scheduling, system and building access, and assure staff availability.
  • Serve as the lead for working with internal and external audit teams.
  • Obtain and evaluate an audit’s scope letter, query, claim samples and other provided or requested items. 
  • Work with staff members to provide input, evidence and documentation for Medicaid and Medicare audits and coordinate responsive and comprehensive replies.
  • Coordinate all information for pre audit and post audit as well as ad hoc data reports related to audits. 
  • Review audit findings with appropriate teams to ensure accuracy. Manage all corrective action plans and work with staff to update policies and procedures. Perform follow-up activities related to audits/reviews and special projects including ensuring corrective action has been completed. Report findings and observations. 
  • Provide training to internal staff in completing their assignments as a means of maximizing audit efficiency. 
  • Serve as a point of contact for new and existing staff in answering questions associated with federal and state laws for Medicaid and Medicare. 
  • Serve as coordinator for all Single Case Agreements (SCA) for Medicaid including reviewing provider eligibility for SCA, reaching out to offices to sign SCA and transfer and complete warm handoff to Professional Relations for any providers interested in joining the network, ensuring claims are adjusted appropriately and documented accurately in HDS based on SCA agreement decision, and comply with Medicaid audit and reporting requirements for all agreements. 
  • Perform other duties as assigned.
Requirements

    

Hiring Specifications:

  1. Bachelor's degree in Public Health, Health Care Administration, Health Policy, Business Administration or related field or equivalent experience. 
  2. Project management skills, including strong analytical capacity, proven ability to facilitate teams and guide operational implementation.
  3. 3-5 years of regulatory compliance and/or audit experience in Medicare and/or Medicaid operations.
  4. Solid writing skills including mastery of grammar, punctuation, and ability to explain reasonably complex concepts. 
  5. Demonstrated ability to multi-task responsibilities and to manage workloads to established deadlines.
  6. Strong ability to organize, analyze and solve complex problems with attention to detail and accuracy. 
  7. Experienced in handling information in a confidential manner and maintain compliance with policies and federal/state laws.
  8. Ability to communicate both verbally and in writing with all levels of staff, customers, and providers. 

Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.


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