Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

The External Auditor is responsible for conducting audits and ensuring regulatory compliance in the determination of program reimbursement for assigned providers. This position is responsible for conducting financial analysis, limited and full desk reviews, and in-house and on-site field audits to ensure regulatory compliance, performance, and proper reimbursement for health care providers/vendors/facilities contracted with CareOregon. These reviews may be internal (of CareOregon) or external (of providers/vendors/facilities). The External Auditor will interact with providers/vendors/facilities management through the audit process which requires an advanced level of professionalism. The External Auditor will review assigned portions of audit programs, determine compliance with policies and procedures, recommend corrective action plans, and prepare and submit reports on the results of audits. The External Auditor will report to the VP of Audit and Compliance as part of the Internal Audit team.

Essential Responsibilities

• Conduct financial analysis, limited and full desk reviews, and in-house and on-site field audits.
• Ensure regulatory compliance, performance, and proper reimbursement for entities contracted with CareOregon.
• May conduct internal (of CareOregon) or external (of providers/facilities) reviews.
• Interact with providers/facilities management through the audit process.
• Review assigned portions of audit programs, determine compliance with policies and procedures, recommend corrective action plans, and prepare and submit reports on the results of audits.
• Provide results of reviews to the VP of Audit and Compliance as part of the Internal Audit team.
• Ensure reimbursement principles are properly applied so that reimbursement is accurate.
• Provide professional judgement, strategic insight, and guidance using knowledge, experience, and research to ensure quality control is adequate and minimize risk for the team and organization.
• Enhance and maintain strong, professional working relationships with entities.
• Provide training to internal staff and participate in external outreach and education to the provider community.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures, and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years' experience in Accounting, Compliance, Internal Audit, External Audit, or related field

Preferred

• Certification as CPA, CPC, CIA, or CFE

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge of Medicaid and Medicare rules, regulations (e.g. Code of Federal Regulations, Provider Reimbursement Manual) to ensure the reimbursement principles are properly applied

• Knowledge of ICD-10 and CPT coding
• Knowledge of accounting theory and practices
• Extensive knowledge of documentation requirements from audit testing through preparation of audit workpapers

Skills and Abilities

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint)

• Excellent written and verbal communication skills, including presentation skills
• Excellent organizational skills and demonstrated ability to work independently

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.