Job description

The United Mine Workers of America Health and Retirement Funds (the Funds) has an opening for a Senior Manager, Regulatory Audit Compliance. The Funds is a group of six multi-employer plans that provide health and pension benefits primarily to retired coal miners and their eligible dependents.

The Senior Manager, Regulatory Audit Compliance will be responsible for managing and leading the Funds’ Centers for Medicare and Medicaid Services (CMS) Audit program. Duties include, but are not limited to, the following:

• Provides industry expertise for best practices in audit procedures and CMS audit compliance
• Envisions and implements enhancements to the Funds CMS Audit program
• Prepares, plans, and leads the Funds’ response to and participation in the CMS Audits
• Organizes an audit team to collect considerable amounts of clinical information for review by auditors
• Leads the team to investigate and review claims, medical records, and other documentation received from providers in correlation with other audit activities taking place
• Develops standard operation procedures, prepares audit tracking system, audit communications, staff training, medical record review and exception review, audit responses, reporting, compliance with audit deadlines, and oversight of coding consultants
• Directs and oversees the Funds’ contracted audit vendors

Candidates should possess a Bachelor’s degree from a four-year college or university plus six years related experience in an audit environment and/or training; or equivalent combination of education and experience. Requires expert knowledge of CMS audit procedures, medical record retention and storage policies, as well as detailed knowledge and understanding of medical benefits. Experience working within and monitoring a high-volume medical audit preferred.

Positions with the UMWA Health and Retirement Funds require COVID-19 vaccination subject to applicable state and federal law. Offers of employment for this position are conditioned upon the successful candidate providing proper proof of vaccination status prior to employment and pursuant to applicable law.

The Funds offers:

• excellent benefits package
• 35-hour workweek
• 401(k) plan
• pension
• tuition reimbursement
• 13 paid holidays

Complete background check required. Please send your resume, cover letter, and writing sample to:

UMWA Health & Retirement Funds

2121 K Street, NW, Suite 350

Washington, DC 20037

Attn: Hiring Manager/Senior Manager, Regulatory Audit Compliance

EEO/M/F/D/V

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Washington, DC 20037

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