Executive Service

TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

This position requires a background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS). TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

How you make a difference in this role:

The purpose of TennCare's Office of Audit & Investigations is to provide independent, objective assurance and consulting services designed to add value and improve TennCare operations. Our internal auditors and IT auditors perform audits of TennCare's business processes, systems/applications, fiscal transactions, and external partners to ensure compliance with state and federal law, identify potential risks, and recommend solutions to ultimately better the overall organization. The purpose of TennCare's Office of Audit & Investigations is to provide independent, objective assurance and consulting services designed to add value and improve TennCare operations. Our internal auditors perform audits of TennCare's business processes, fiscal transactions, and external partners to ensure compliance with state and federal law, identify potential risks, and recommend solutions to ultimately better the overall organization.

Job Overview:

1. Leads assigned staff auditors in conducting audits of TennCare's business processes, fiscal transactions, and external partners.
2. Reviews the work of assigned staff auditors to ensure accuracy and completion.
3. Analyzes the results of audits, reviews detailed reports that document the extent and scope of the examination, identifies problems, and recommends possible solutions.
4. Facilitates enterprise-wide preparation of annual risk assessments to ensure compliance with Tennessee's Financial Integrity Act, TCA 9-18-101, and the Standards for Internal Control in the Federal Government (Green Book).
5. Participates in peer reviews of other State Agencies to ensure compliance with established auditing standards (i.e., Institute of Internal Auditors' International Standards for the Professional Practice of Internal Auditing (Red Book) or Government Auditing Standards (Yellow Book). This job requires the ability to:
6. Work well independently and in a group setting.
7. Effectively communicate, both written and verbally, with internal and external parties by conveying information in a clear, concise, and professional manner.
8. Establish meaningful working relationships to ensure effective goal achievement.
9. Manage workload and be able to work on multiple projects simultaneously.
10. Independently perform compliance reviews of external parties. This includes:
    1. Annual Fraud, Waste & Abuse reviews of TennCare's Managed Care Contractors
11. Subrecipient reviews to determine if the subrecipient is in compliance with the grant contract and to determine if the invoices submitted to TennCare are accurate and supported by adequate documentation
12. Lead assigned staff auditors in conducting audits of TennCare's business processes/operations. This requires the ability to document business processes, identify controls that should be tested, develop and execute procedures to test these controls, and identify any inefficiencies in the process or any control gaps.
13. Review the work of assigned staff auditors to ensure accuracy and completion.
14. Prepare audit reports summarizing the work performed and any issues/recommendations resulting from the review.
15. Facilitate the enterprise-wide preparation of annual risk assessments to ensure compliance with Tennessee's Financial Integrity Act, TCA 9-18-101, and the Standards for Internal Control in the Federal Government (Green Book).
16. Participate in peer reviews of other State Agencies to ensure compliance with established auditing standards

Minimum Qualifications:

Graduation from an accredited four-year college or university with a bachelor's degree in accounting or a Public Accountant in good standing and experience equivalent to three years of full-time increasingly responsible professional auditing work.

OR

Graduation from an accredited college or university with a bachelor's degree including thirty-six quarter hours in accounting and experience equivalent to three years of full-time increasingly responsible professional auditing work.

OR

A Certified Public Accountant with the State of Tennessee and experience equivalent to two years of full-time increasingly responsible professional auditing work. Substitution of Education for Experience: Additional graduate coursework in business administration with a major in accounting may be substituted for the required experience, on a year-for-year basis, to a maximum of one year. Desirable Qualifications

• Experience or proficiency in Microsoft Word, Excel, and PowerPoint.
• Experience or proficiency in electronic work paper software, such as HighBond.
• Knowledge of health care industry, IIA Auditing Standards, and COSO's Internal Control Framework.
• Relevant credentials such as Certified Public Accountant (CPA) with the State of Tennessee, a Certified Internal Auditor (CIA), or Certified Fraud Examiner (CFE).

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.