Hispanic Alliance for Career Enhancement
Senior Manager, Compliance Business Manager-Network Management
Hispanic Alliance for Career Enhancement, Hartford, Connecticut, us, 06112
At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
This exciting role is a fast-paced healthcare provider support role, intended to foster a positive provider experience by supporting the end-to-end process of defining and supporting SOC and SOX controls through collaborating with cross-functional teams. This position will support network across all lines of business.
Responsibilities
Understanding the business to identify when a new control is required
The facilitation of business process and control documentation, which includes writing new controls and ensuring controls are designed appropriately to manage risk
Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes or other updates
Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the control environment, and introduce operational efficiencies
Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made
Responsible for monthly and bi-annual control review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule and Rate Load Tracking Database audits
Support audits out of QNXT and PRMS to support Medicaid SOC and SOX controls
Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies
Must exhibit leadership qualities, strong communication skills, and strategic thinking
Able to drive decisions based on data analysis
May be asked to support other projects as needed based on business need
**This position can be remote or hybrid depending on candidate location and commutable distance to office.**
Required Qualifications
5+ years compliance and/or audit experience in SOC and SOX controls
5+ years of project management experience
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As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
This exciting role is a fast-paced healthcare provider support role, intended to foster a positive provider experience by supporting the end-to-end process of defining and supporting SOC and SOX controls through collaborating with cross-functional teams. This position will support network across all lines of business.
Responsibilities
Understanding the business to identify when a new control is required
The facilitation of business process and control documentation, which includes writing new controls and ensuring controls are designed appropriately to manage risk
Identify and proactively notify all impacted areas of control changes that may require enhancements, process changes or other updates
Partner with stakeholders to continuously evaluate and recommend opportunities to reduce risk, strengthen the control environment, and introduce operational efficiencies
Accountable for all steps within the life cycle of control testing including conducting walkthroughs with Internal and External auditors, maintaining Information Provided by Entity (IPE) and providing documentation as needed when audit selections are made
Responsible for monthly and bi-annual control review, including audits of Provider Tab and Rate Wizard transactions, Fee Schedule and Rate Load Tracking Database audits
Support audits out of QNXT and PRMS to support Medicaid SOC and SOX controls
Coordinate with applicable reporting areas as needed to ensure reports are generated timely and are continuously reviewed for process efficiencies
Must exhibit leadership qualities, strong communication skills, and strategic thinking
Able to drive decisions based on data analysis
May be asked to support other projects as needed based on business need
**This position can be remote or hybrid depending on candidate location and commutable distance to office.**
Required Qualifications
5+ years compliance and/or audit experience in SOC and SOX controls
5+ years of project management experience
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