Lead Audit Specialist

Job Summary

Leading and coordinating all phases of external regulatory audits, the full-time remote Lead Audit Specialist will manage Medicare Advantage, Medicare Part D, Medicaid Managed Care, and Commercial plan audits, ensuring timely and accurate data submissions while providing operational and regulatory guidance.

Key responsibilities

• Manage the coordination of various audits including HHS ACA RADV IVA, CMS MA contract level RADV, and commercial product-related audits
• Lead the full audit lifecycle, serving as the primary liaison to external auditors and coordinating audit activities across operational areas
• Provide routine audit monitoring reports and conduct trend analysis to strengthen regulatory compliance and audit readiness

Required qualifications

• Bachelor's Degree
• 5 - 8+ years of relevant professional work experience in the healthcare industry, specifically in audits
• Extensive knowledge of Medicare Advantage and Medicare Prescription Drug Programs, as well as familiarity with regulatory audit processes
• Proficiency in Microsoft Office applications
• Strong analytical skills and the ability to manage multiple tasks with competing deadlines