Behavioral External Audit Advisor - Evernorth Behavioral Health - Hybrid

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.


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