Medicare Advantage External Audit Specialist

Das ist der Job

Serve as the primary liaison between auditors, regulators, health plan clients, and internal operational departments.

Darum lohnt es sich

Ability to interact professionally with regulators, auditors, clients, executives, and operational teams. Proficiency with Microsoft Office Suite, including Excel, Word, PowerPoint, and Teams.

Responsibilities Coordinate all aspects of external client, regulatory, and compliance audits involving Medicare Advantage, SNP, Part D, and Managed Medicaid plans and related healthcare operations. Manage audit timelines, deliverables, evidence requests, and response tracking.

Coordinate collection, validation, organization, and submission of audit documentation and supporting evidence. Schedule audit meetings, interviews, walkthroughs, and status updates with internal and external stakeholders.

Monitor audit progress and communicate status updates, risks, and deadlines to Chief Compliance Officer and Compliance Committee. Track audit findings, corrective actions, remediation plans, and response due dates. Assist with preparation for recurring CMS, client, and regulatory oversight activities.

Support internal compliance and vendor oversight audit activities. Assist with compliance monitoring and oversight activities across operational areas. Support policy and procedure review and maintenance activities. Assist with issue tracking, investigations, and documentation management.

Participate in internal risk assessments and compliance reviews. Support preparation of compliance reports, dashboards, presentations, and committee materials. Maintain strict confidentiality of Protected Health Information (PHI), proprietary information, and sensitive client data.

Maintain awareness of applicable CMS Medicare Advantage regulations, guidance, and audit expectations. Requirements Bachelor’s degree or equivalent experience in healthcare administration, business administration, compliance, legal studies, public health, finance, or related field preferred.

Minimum of 2–5 years of experience in Medicare Advantage audit coordination or project management of CMS audits, delegation oversights, data validation audits, financial audits, and/or HIPAA audits. Experience coordinating external audits, regulatory requests, or client oversight activities preferred.

Strong project coordination and organizational skills. Excellent written and verbal communication abilities. Ability to manage multiple priorities and deadlines simultaneously. Strong follow-through, accountability, and time management skills. Attention to detail and documentation accuracy.

Compliance certification preferred, such as Health Care Compliance Association CHC, CHPC, CCEP, or similar. #J-18808-Ljbffr