5-7 years of experience in compliance auditing, specifically in Medicare Advantage and Part D programs.
Strong understanding of CMS and DMHC regulations.
Proven ability to conduct risk-based audits and prepare detailed reports.
Experience in collaborating with internal teams and external partners.
Familiarity with audit toolkits and compliance metrics tracking.
Responsibilities
Conduct compliance audits on operational functions and vendor performance.
Design and enhance audit toolkits for Medicare Advantage and Part D.
Collaborate with stakeholders to identify compliance risks.
Document audit activities and findings comprehensively.
Prepare professional audit reports for leadership and regulatory bodies.
Support organization-wide audit readiness and regulatory preparedness.
Coordinate external audits and manage responses to regulatory agencies.
Benefits
Opportunity to work in a vital role within a leading healthcare organization.
Engagement with a diverse range of compliance-related tasks.
Collaboration with experienced professionals in the field.
Access to training and development opportunities.
Contribution to improving regulatory readiness and operational efficiency.
Full Job Description
Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization.
Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization's audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners.
In this role, you will:
Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, Triennial Review, pre-delegation reviews, and more.
Design and improve audit toolkits based on Medicare Advantage and Part D risk areas.
Collaborate with stakeholders and leadership to identify and address compliance risks.
Maintain comprehensive documentation of audit activities and findings.
Prepare detailed and professional audit reports for senior leadership and regulatory bodies.
Support organization-wide audit readiness and regulatory preparedness.
Coordinate external audits and ensure timely responses to agencies such as CMS or DMHC.
Assist in training internal teams on compliance auditing procedures and best practices.
Track and report compliance metrics, risk trends, and audit performance indicators.
Salary Range: $88,900 - $190,300/annually
About UCLA Health
UCLA Health is a world-renowned academic medical center located in Los Angeles, California. It comprises four hospitals, including Ronald Reagan UCLA Medical Center, and more than 200 primary and specialty care clinics. UCLA Health is affiliated with the David Geffen School of Medicine at UCLA and is consistently ranked among the top hospitals in the United States. The health system employs over 20,000 people and serves as a major center for patient care, medical education, and research.
