Mgr, Audit Readiness
Horizon Blue Cross Blue Shield of New Jersey · Newark, New Jersey, US
Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solution...
Job description
Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years , we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. About the Role: This position manages the execution of the annual Federal Govt initiated regulatory audits and serves as the organizational liaison with CMS for Commercial/GP. This position collaborates with all levels of business partners across the Enterprise to resolve negative audit results which are subject to all levels of corrective action from CMS. The incumbent will lead a team of analysts that will review the findings, which can include civil monetary penalty, discontinuation of Medicare contracts, reject plans for expansion, suspe...