The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Under the direction of the Compliance Officer and Compliance Department management, the Compliance Auditor is responsible for working independently on assigned projects to ensure health plan compliance with Medicare (Part C and D), NYS Medicaid and MLTC regulations. Initiates and perform audits and monitoring activities of various health plan operations, such as appeals and grievances, claims, medical management, customer service, provider relations and contracting, sales and enrollment, and other functions to ensure proper compliance with governmental regulations and health plan policies.