Medicare Advantage External Audit Specialist

Roles And 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.
• Cook up 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.
• Aid in the preparation for recurring CMS, client, and regulatory oversight activities.

Internal Compliance Program Support

• 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.
• Aid in issue tracking, investigations, and documentation management.
• Support preparation of compliance reports, dashboards, presentations, and committee materials.
• Maintain strict confidentiality of Protected Health Information (PHI), proprietary information, and sensitive client data.

Regulatory & Operational Awareness

• Maintain awareness of applicable CMS Medicare Advantage regulations, guidance, and audit expectations.
• Monitor regulatory changes impacting compliance operations and audit readiness activities.

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, PowerPoint, and Teams.
• Compliance certification preferred, such as Health Care Compliance Association CHC, CHPC, CCEP, or similar.

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

Compliance

This job description is intended to convey information essential to understanding the scope of the position and is not an exhaustive list of efforts, duties, responsibilities, or working conditions associated with it. Duties, responsibilities, and activities may change at any time with or without notice.