Medicare Advantage External Audit Specialist

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.
• Serve as the primary liaison between auditors, regulators, health plan clients, and internal operational departments.
• 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.
• Ability to interact professionally with regulators, auditors, clients, executives, and operational teams.
• Proficiency with Microsoft Office Suite, including Excel, Word, Power Point, and Teams.
• Compliance certification preferred, such as Health Care Compliance Association CHC, CHPC, CCEP, or similar.
• #J-18808-Ljbffr