What are the responsibilities and job description for the Director, Healthcare Audit Practice position at Gallagher Benefit Services?
Discover a world of endless possibilities at Gallagher Benefit Services, where you'll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock potential, and create a legacy of remarkable transformation.
We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.
Overview
This position will report to the Principal and Healthcare Audit Practice Leader and will be responsible for overseeing the day to day operations of the Medical Audit division as well as assist with audit work as needed/assigned. Medical audits validate that the coverage of a service and the payment of such service are in compliance with the contractual, regulatory, and custom plan guidelines. This position is client facing and requires an individual who can effectively manage client expectations and oversee staff.
Managerial Responsibilities: (include but are not limited to)
Manage assigned team members related to day-to-day operations and workflow:
o First point of contact for questions/issues
o Escalate issues to Practice Leader as necessary in a timely manner
o Perform detailed QA review of all claim samples, audit workpapers and audit reports prior to
Practice Leader review
o Review and evaluate Administrative Services Agreement between the employer and
Administrator to confirm audit rights and contractual performance guarantee information.
o Review and understand audit statement of work to ensure that staff is adhering to agreed upon
scope and timelines.
o Participate in client and Administrator calls to support staff
o Train new staff and provide coaching and feedback to all staff on a regular basis
o Hold weekly team meetings and one on ones with staff
o Work with Practice Leader and other practice Directors on process improvement initiatives
o Provide feedback on staff performance for year-end review process
Detailed Audit Responsibilities: (include but are not limited to)
Manage and perform audits of medical claim payment data to validate conformance with contractual requirements and plan specifications as assigned.- Work with Data Analytics to define and translate plan provisions for testing purposes ensuring that scope is in line with statement of work and client commitments. Review client specific documentation, Summary Plan Description(s) and other documentation to develop the audit test filters.
- Complete coding of audit tool with Plan parameters or assist with completion of audit tool coding as assigned.
- Evaluate the results of the ERA (Electronic Risk Assessment) or audit tool output and determine or assist staff with determining valid audit sample for review with Administrator.
- Support auditors and audit coordinators to prepare Administrator and client communications regarding audit samples, audit issues, expectations, and clarifications to questions/responses.
- Prepare, review and present various client communications, including but not limited to audit samples, mid-Point discussion documents, draft, and final audit reports and status updates.
- Work collaboratively with Administrators to resolve exceptions, review supporting documentation and make final claim error determination.
- Ensure audit timeline is adhered to and deliver high level of service to clients.
- Prepare, review and present audit reports which clearly articulate audit findings and recommendations to Administrators and client - Maintain audit work papers to support audit findings
- Work collaboratively within the audit team as well as with internal and external customers.
- Participate in team meetings, conference calls, etc remotely / locally with administrators and audit team as necessary.
About You
Education/Work Experience
- College degree (experience may be considered in waiving the degree requirement)
- 10 years’ experience in leadership, medical claim administration, healthcare consulting, healthcare audit or other applicable industry experience
- Previous internal or external Administrator audit experience is a plus
Proficiencies of Skills
- Managerial experience required
- Must demonstrate a high level of medical claim industry and administration knowledge
- Medicare knowledge a strong plus
- Proficient in the use of Microsoft Office Software (i.e., Word, Excel, PowerPoint)
- Strong organizational skills with an ability to manage time efficiently and handle changing or conflicting priorities
- Attention to detail and ability to clearly explain thought process in reaching documented conclusions
- Excellent oral and written skills required
- Self-directed individual who requires little supervision and can manage multiple projects effectively to ensure deadlines are met
- Team player with a strong work ethic and drive for growth
Compensation and benefits
On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:
- Medical/dental/vision plans, which start from day one!
- Life and accident insurance
- 401(K) and Roth options
- Tax-advantaged accounts (HSA, FSA)
- Educational expense reimbursement
- Paid parental leave
Other benefits include:
- Digital mental health services (Talkspace)
- Flexible work hours (availability varies by office and job function)
- Training programs
- Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
- Charitable matching gift program
- And more...
We value inclusion and diversity
Click Here to review our U.S. Eligibility Requirements and Pay Disclosure Statement
Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
