Medicare Advantage External Audit Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee all facets of external client, regulatory, and compliance audits related to Medicare Advantage, SNP, Part D, and Managed Medicaid plans, as well as associated healthcare operations.

• Act as the main point of contact between auditors, regulators, health plan clients, and internal operational teams.

• Administer audit schedules, deliverables, evidence requests, and tracking of responses.

• Coordinate the gathering, validation, organization, and submission of audit documentation and necessary supporting evidence.

• Arrange audit meetings, interviews, walkthroughs, and status updates with both internal and external parties.

• Oversee audit progress and relay status updates, risks, and deadlines to the Chief Compliance Officer and the Compliance Committee.

• Monitor audit findings, corrective actions, remediation plans, and deadlines for responses.

• Assist in preparing for ongoing CMS, client, and regulatory oversight activities.

• Provide support for internal compliance and vendor oversight audit initiatives.

• Aid in compliance monitoring and oversight functions across operational areas.

• Contribute to the review and maintenance of policies and procedures.

• Assist with tracking issues, investigations, and managing documentation.

• Engage in internal risk assessments and compliance evaluations.

• Help prepare compliance reports, dashboards, presentations, and materials for committees.

• Ensure strict confidentiality of Protected Health Information (PHI), proprietary information, and sensitive client data.

• Stay informed about relevant 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 a related field is preferred.

• A minimum of 2–5 years of experience in coordinating Medicare Advantage audits or managing CMS audits, delegation oversights, data validation audits, financial audits, and/or HIPAA audits.

• Previous experience in coordinating external audits, regulatory requests, or client oversight activities is preferred.

• Proven project coordination and organizational abilities.

• Exceptional written and verbal communication skills.

• Capacity to manage multiple priorities and meet deadlines concurrently.

• Strong follow-through, accountability, and time management capabilities.

• Keen attention to detail and accuracy in documentation.

• Proficient in interacting professionally with regulators, auditors, clients, executives, and operational teams.

• Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, and Teams.

• Compliance certification is preferred, such as Health Care Compliance Association CHC, CHPC, CCEP, or a similar credential.

🏝️ Benefits

• 100% remote work culture

• 5 weeks of vacation

• Health, dental & vision insurance

• Traditional and ROTH 401k with company match

• Company paid life insurance, AD&D, and long-term disability coverage

• HSA and FSA accounts

• Tuition Reimbursement

• Parental Leave