Risk Strategies Consulting (RSC) is seeking a dynamic Audit Leader to join our team and revolutionize the healthcare audit landscape. As a key member of our leadership team, you will play a pivotal role in developing leading audit solutions that address the evolving needs within the healthcare ecosystem.The ideal candidate will have the opportunity to leverage a deep understanding of audit principles and frameworks to create innovative, market-leading audit solutions while leading and developing a high-performing audit team, ensuring efficient and effective operations. This individual will utilize data analytics to optimize audit processes and share expertise and insights to position RSC as a thought leader in the healthcare audit industry.Risk Strategies Consulting (RSC) has an exciting opportunity for an experienced audit leader. The ideal candidate is naturally curious and inquisitive and has audit experience related to medical claims, pharmacy claims, member experience, large claims, payment integrity and/or stop/loss coverage coupled with the technical acumen for creating audit automation.The candidate must be adept with data and analytics and will be responsible for operational audit capabilities. The candidate must have a proactive approach to work, a problem-solving aptitude, and be willing to learn and adapt. The candidate will be motivated, well-organized, and a self-starter that thrives in a fast-paced and dynamic work environment.Primary Duties & Responsibilities:
- Develop a clear and relevant vision for the RSC Audit practice including a short, mid, and long-term growth plan including KPIs to measure success.
- Define and develop tools that demonstrate the success of audit solutions to enable effective controls, address gaps, and provide ROI validation.
- Leverage best practices and standard audit principles to create methodologies that can drive innovation and value across the healthcare ecosystem.
- Enhance existing and introduce new audit capabilities, automation, best practices, work products, functions, and concepts.
- Create structure, process efficiencies, standard operating procedures, and documentation to effectively scale the breadth and depth of the audit practice capabilities.
- Interface directly with clients, key stakeholders, and senior leadership.
Requirements & Qualifications:
- Master's Degree and/or an advanced degree in Accounting, Healthcare or Technology related field.
- Proven experience (7+years) in healthcare audit, with a focus on medical claims, pharmacy claims, member experience, large claims, payment integrity, or stop/loss coverage.
- Ability to evaluate complex business requirements for the purpose of developing
- comprehensive and innovative solutions.
- Proven leadership success that demonstrates proactive planning and achieving quality results individually and against companywide goals and objectives.
- Excellent communication, analytical, technical, conceptual, and problem-solving skills.
Preferred Qualifications:
- Knowledge of healthcare data as hospital/physician /ASC claims, utilization data, and healthcare industry coding systems ICD-10, CPT/HCPCS, Revenue Codes, MS/APR-DRGs and APC.
- Revenue cycle management experience.
- Certified Healthcare Internal Audit Professional certification.
- Certified Professional Medical Auditor
At Risk Strategies Company, base pay is one part of our total compensation package, which also includes a comprehensive suite of benefits, including medical, dental, vision, disability, and life insurance, retirement savings, and paid time off and paid holidays for eligible employees. The total compensation for a position may also include other elements dependent on the position offered. The expected base pay range for this position is between $151,000 - $250,000 annually. The actual base pay offered may vary depending on multiple individualized factors, including geographical location, education, job-related knowledge, skills, and experience.Risk Strategies is the 9th largest privately held US brokerage firm offering comprehensive risk management advice, insurance and reinsurance placement for property & casualty, employee benefits, private client services, as well as consulting services and financial & wealth solutions. With more than 30 specialty practices, Risk Strategies serves commercial companies, nonprofits, public entities, and individuals, and has access to all major insurance markets. Risk Strategies has over 100 offices and nearly 5,000 employees across the US and Canada.Our industry recognition includes being named a Best Places to Work in Insurance for the past five years (2018-2022) and on the Inc. 5000 list as one of America's Fastest Growing Private Companies. We are committed to being good stewards for our company, culture, and communities by having a strong focus on Environmental, Social, and Governance issues.Risk Strategies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies by visiting our careers page: www.risk-strategies.com/careers.