Healthcare Vendor Auditor

Job Summary

Conducting independent claims and vendor performance audits, the full-time remote Vendor Auditor will ensure compliance with contractual obligations and regulatory requirements while managing the organization's highest-risk vendor population.

Key responsibilities

• Evaluate claims accuracy and monitor vendor performance to identify operational risks and recommend corrective actions
• Analyze medical, pharmacy, and PBM claims data, performing root cause analysis of discrepancies and trends
• Prepare formal audit reports, present findings to leadership, and oversee remediation efforts while maintaining vendor performance scorecards

Required qualifications

• College degree preferred in Nursing, Accounting, Business, or Healthcare; three years of advanced claims auditing experience may substitute for a degree
• Advanced knowledge of claims adjudication, Medicare and Medicaid reimbursement, and healthcare reimbursement policies
• Experience in analyzing claims data and conducting compliance audits
• Strong analytical and critical thinking skills
• Ability to work independently and manage multiple priorities effectively