Qualifications

• Bachelor's degree in health care administration, political science, social science, or related field required.
• Minimum of three years healthcare audit experience, preferably within a health insurance plan.
• Strong understanding of Medicare and Medicaid programs preferred.
• In-depth knowledge of industry rules, guidelines, and regulations is essential.
• Billing and coding experience is a plus.
• Demonstrated strong analytical and statistical skills with attention to detail.

Responsibilities

• Assist in conducting enterprise-wide risk assessments and contribute to the annual compliance audit plan.
• Design and implement risk-based audit programs for compliance assessment.
• Perform audits and monitoring activities as per the approved audit plan.
• Identify and document root causes of compliance risks with defensible evidence.
• Effectively communicate audit results supported by data and analysis.
• Collaborate with operational leaders to develop and validate corrective action plans.
• Monitor audit outcomes and trends, reporting progress to compliance leadership.

Benefits

• Collaborative work environment that values solution-oriented approaches.
• Opportunities for professional development and training in compliance.
• Access to current industry knowledge and regulatory guidance.