Healthcare Compliance Consulting (Remote)

Who We Are:

Advent Advisory Group LLC (Advent) is a healthcare consulting company, recognized as an industry leader in providing audit, consulting and technical assistance to health service organizations nationwide. We are a National Committee for Quality Assurance (NCQA) licensed audit organization, Centers for Medicare and Medicaid Services (CMS) approved Part C and Part D data validation organization, and a URAC pharmacy approved audit organization, and have been providing audit and consulting services for some of the largest health services companies in the country for over 15 years. Advent, a woman-owned business, is a dynamic and growing business, recognized by Inc. 5000 in 2017 and 2019 as one of the fastest growing private companies in the country.

About the Role:

The Client Manager is responsible for providing compliance auditing, consulting, and data validation services to health care services organizations nationwide and reports to the Program Director. This is a fully remote position.

What you’ll do:

• Perform rate review, benchmark comparisons, longitudinal assessments, data analysis, and other evaluations to identify potential issues in reporting.
• Provide ongoing audit support and analytical services, including, but not limited to, data review and validation; analysis of methodologies, systems and processes; schematics, primary source verification, documentation of review results, conduct audit onsite (virtually or in person), and other IT-related tools and documentation.
• Assist with program development, implementation and strategic planning, including developing, testing and updating audit tools, client communications, process improvement of audit tools and processes, and other supporting documentation.
• Other job responsibilities as required.
• Serve as lead and/or secondary auditor and provide related audit and consulting services; manage all aspects of program compliance audits, including, but not limited to, rendering audit decisions, completing required audit tools, managing client interactions, collaborating with audit teams, generating audit findings documents, interpreting technical specifications, conveying audit impact, responding to client inquiries, and ensuring client deliverables.
• Maintain technical expertise in current and future regulatory or accreditation technical specifications and audit and reporting requirements.
• Assist in the development of program specific resources (webinars, technical white papers, website content, etc.)

Education and Experience:

• Previous experience working for a pharmacy, health plan, health system or vendor required.
• Minimum 5 years’ experience working in health care data analytics, compliance, performance measurement, IT, programming, systems development, or other related experience at a health plan or health system required
• Ideal candidate will have at least 5 years’ CMS Part C and D reporting, pharmacy, HEDIS or related compliance experience
• Bachelor’s degree in business, social science, statistics, biological or technical science or other related field required; Master’s degree preferred

Skills and Abilities:

• Understanding of HIPAA and Privacy requirements required.
• Minimal travel, including to annual company meeting, required.
• Ability to understand clinical data, complex health care systems, analyze data, interpret results required.
• Large health plan or health services organization experience preferred.
• Previous experience working in a fully remote setting preferred.
• Exceptional analytical, writing, interpersonal, communication and project management skills required.
• Extensive knowledge of managed care industry, healthcare delivery systems, pharmacy benefits operations, claims and medical records data, data quality management and performance measurement required.
• Ability to work across multi-disciplinary remote teams, including clinical, IT, development, and administration required.
• Proficient in MS Team, Word, Access and Excel Microsoft applications required.
• Exceptional critical thinking and interpersonal skills and the ability to make decisions based on facts and data required.

Compensation and Benefits:

• Salary commensurate experience
• Medical, Dental and Vision Coverage
• 401(k)
• Company Paid Life Insurance
• 20 days of PTO annually

We are an Equal Opportunity Employer!