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Manager Of Audit, Compliance Office Resume

Tinton Falls, NJ

TECHNICAL SKILLS:

ERP Software: Lawson; SAP; PeopleSoft; FRS; SMS; Great Plains;

Audit Related Software: AutoAudit; ACL; E&Y audit software;

Microsoft Systems: Office Suite (proficient in Excel, Word and Outlook);

Other Software: Cerner; QuadraMed; CliniComp; IDX; Crystal Reports; Impact; Cactus.

WORK EXPERIENCE:

Manager of Audit, Compliance Office

Confidential, Tinton Falls, NJ

Responsibilities:

  • A $500 million full service third party administrator, provider network and leading health plan management company serving customers throughout New York, New Jersey and Connecticut, with 5 offices and 250 employees. Formerly known as Confidential .
  • Devise and implement Compliance review and audit programs or monitoring for all areas including provider network/directory and credentialing, claims processing and appeals, mailroom functions, company licensing and registrations, client bank accounts and required regulatory filings
  • Manage ongoing HIPAA privacy and security reviews, including maintenance of and updates to related policies and annual and other periodic employee training
  • Develop, review and maintain corporate policies based on results of compliance - related evaluations
  • Investigate potential unauthorized PHI disclosures, including requisite client or regulatory reporting
  • Coordinate organization-wide HIPAA Security Risk Assessments working with an outside vendor, including on-site review, reporting and action plan and ongoing mitigation steps
  • Facilitate annual Statement on Standards for Attestation Engagements (SSAE) audits by outside vendor
  • Manage and review, information gathering and response to periodic (monthly, quarterly or annual) requests from federal, state and local regulatory agencies and corporate investors
  • Manage investigation into and response to member calls pertaining to company fraud, waste and abuse
  • Facilitate the comprehensive review, compilation and completion of previously undocumented business associate agreements between clients, vendors and other business associates
  • Conduct periodic review of contracts and agreements for HIPAA compliance, including collaboration with legal and other departments as needed.

Senior Auditor

Confidential, San Diego, CA

Responsibilities:

  • A $2.5 billion private, nonprofit, integrated health system, with 5 hospital campuses, over 30 outpatient centers and clinics, over 2,600 affiliated physicians and over 13,000 employees - the system has executed a voluntary SOX 404 internal controls initiative to identify, evaluate and catalogue over 1,100 financial reporting controls
  • Performed internal audit duties including risk assessment, project planning and related preparation and review of reports including audits of employee care clinic, 340B pharmacy drug discount program, payments to physicians, review of the self-insured health claims third party administrator, medical group acquisitions, document destruction consoles, provider (physician) services agreement compensation, employee benefit eligibility and assorted other financial, accounting and operational controls. Led review of vendor contract / process identifying estimated annual savings of over $240,000
  • Communicated with and presented audit findings and recommendations directly to management detailing internal control and operational improvement recommendations
  • Proficient at evaluation of internal controls, including accounting, finance, and operational processes, and participant in fraud-related investigations
  • Coordinated and participated in process improvement planning for audit projects
  • Provided recommendations for and implemented procedures to improve internal audit practices
  • Facilitated Internal Audit collaboration with Compliance division in Audit & Compliance Services department as appropriate
  • Implemented and maintained continuous financial monitoring using ACL/Audit Exchange improving efficiency in prevention and detection of potential fraudulent activities
  • Participated in fiscal 2011, 2012 and 2013 external financial statement audit procedures

Principal Auditor

Confidential, San Diego, CA

Responsibilities:

  • Managed, prepared, analyzed and reviewed audit work papers and reports for projects in the city’s audit work plan requested by city management and other investigations, including supervision of assigned staff
  • Coordinated and participated in audit planning, including the evaluation of internal controls related to accounting, finance and operational processes and development of annual risk assessment and work plan
  • Prepared and presented audit findings and recommendations to department and city administration
  • Participated in the City’s Disclosure Practices Working Group (DPWG)
  • Presented audit results and guidance to city elected officials and governmental audit seminars

Internal Audit Manager

Confidential, San Diego, CA

Responsibilities:

  • A 2,200 square mile health district with 3 hospital campuses and approximately 3,000 employees;
  • Responsible for the preparation, analysis and review of internal audit reports pertaining to pharmacy services; physician contracting; foundation operations; and accounts payable, including supervision of assigned staff
  • Presented audit findings and recommendations directly to management and administrators
  • Coordinated and participated in process improvement planning for audit projects, including Internal Audit’s association with Compliance on projects and compliance-related training
  • Skilled in evaluation of accounting, finance, and operational processes and internal controls
  • Recommended and implemented procedures to improve internal audit process efficiency and effectiveness
  • Participated as a key collaborator in organization’s recognition as 2006 bronze award winner in California Awards for Performance Excellence (Baldrige based). Acted as an examiner for a separate award winning organization
  • Participated in the Green Initiative steering committee to make recommendations for construction of new medical center in Southern California.

Internal Auditor

Confidential, San Diego, CA

Responsibilities:

  • A $2.7 billion private, nonprofit, integrated health system, with 7 hospital facilities, 2 affiliated medical groups, 2,600 affiliated physicians and over 16,000 employees
  • Coordinated and participated in planning audit projects, including evaluation of internal controls related to accounting, finance, and operational processes
  • Prepared, analyzed and reviewed audit work papers for reviews of hospital pharmacy clinical services, clinical trial processes, and health plan operations
  • Presented audit findings and recommendations to management and hospital administration
  • Participated in planning and preparation for fiscal 2003 and 2004 external audits

Financial Analyst

Confidential, La Jolla, CA

Responsibilities:

  • Reviewed and monitored budget and forecasted financial amounts on a departmental basis
  • Analyzed financial accounts related to intellectual property issues such as patents and technology
  • Participated in planning and preparation for the fiscal 2002 year-end audit
  • Regularly interacted with senior project management and scientists regarding financial issues
  • Prepared and reviewed monthly journal entries and supporting documentation
  • Prepared, reviewed and analyzed Institute funding grants

Senior Auditor,

Confidential, Iselin, NJ

Responsibilities:

  • Prepared, analyzed and reviewed audit work papers for hospital, home care, managed care, pharmaceutical, not-for-profit and SEC clients for all financial statement accounts
  • Analyzed and reviewed client accounts receivable and revenue accounts
  • Coordinated and participated in the planning for year-end audits, including the evaluation of internal controls related to accounting, finance and budgetary processes
  • Supervised, trained, and evaluated a staff of up to three assigned to client engagements
  • Prepared and reviewed audited financial statements and related footnotes disclosures
  • Worked closely with senior management and client executives reviewing audit findings and management recommendations resulting from engagement procedures
  • Conducted quarterly reviews and year-end audits

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