Behavioral External Audit Advisor - Evernorth Behavioral Health - Hybrid (Finance)
ROLE SUMMARY:
The External Audit Advisor assists in the support and coordination of third-party audits of Cigna and Evernorth clinical behavioral programs on behalf of clients. Works closely with Evernorth Clinical Operations to ensure audit readiness and success. Responds to integrated and behavioral audit inquiries from our audit readiness partners based on operating procedures. Assists in the coordination and development of responses and feedback loop development derived from post audit results. Identifies and recommends changes to improvements in department policies, procedures, and assists in the development of audit guidelines. May act as subject matter expert and a resource for team members. An individual contributor working on significant processes utilizing independent judgment and discretion within and/or across various functional areas. Takes responsibility for continuous learning and development of skills necessary to fully support the organization.
MAJOR DUTIES:
- Participation and Engagement in all External Audit Phases for both Integrated and Behavioral Only Audits (Pre-Audit, Audit Prep, Audit Day, Post-Audit) including:
- Participate in client/consultant meetings as needed representing the BH clinical audit process and requirements.
- Manage and ensure completion of administrative tasks in relation to the execution of the audit as assigned.
- Review and research all cases identified for audit inclusion, outlining clear successes, opportunities and risks.
- Create case scripts to outline the case flow, remediating opportunities in real time, if applicable.
- Identify and engage Behavioral Operation Leadership, UM/CM front line staff, EAP, Behavioral /Evernorth account team, provider relations, sales team based on audit scope and need.
- Develop and prep identified case presenters to understand their role, case content, and proactively address opportunities and risks within the case presentation.
- Present cases during audit when applicable, fielding questions from clients and consultants demonstrating business acumen and operational expertise.
- Representative of BH audit team in consultative role within any post audit projects or action planning to ensure follow through on score card responses.
- Assist with building responses to consultant feedback, share knowledge of programmatic initiatives to close gaps, and increase awareness of targets via external audit feedback.
- Responsible for Behavioral Health External Audit database entry, data management and interpretation of data - working to ensure we are tracking consultant feedback, successes.
- In coordination with BH External Audit leadership, ensure feedback loop in place for sharing information, including effective action planning with business, quality team, and other impacted stakeholders to close gaps, enhance business processes and elevate service levels.
- Additional duties as assigned by manager.
SKILLS & ATTRIBUTES:
The Behavioral Health External Audit Advisor must possess the following skills and attributes: excellent analytical skills with attention to precision and detail; ability to manage multiple projects simultaneously; good organizational skills; strong leadership skills, strong interpersonal and teamwork skills; excellent oral and written communication skills; strong technical and computer skill
QUALIFICATIONS:
- Bachelor's degree in a related field
- Clinical expertise strongly preferred
- Experience working directly with clients/consultants preferred
- Skilled in Microsoft Exel data management with experience managing and interpreting data
- Demonstrated project management skills, with ability to organize and drive work
- Strong understanding of non-clinical and clinical Evernorth Behavioral Health operational teams
- Excellent communication, interpersonal, and problem-solving skills.
- Highly skilled in matrix partner collaboration
- Proven ability to learn new systems, technologies and processes quickly and efficiently
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 87,200 - 145,300 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
