Medicare Advantage External Audit Specialist

The Medicare Advantage External Audit Specialist supports external audits for Medicare Advantage, Part D, and SNP health plan clients nationwide. Reporting to the Chief Compliance Officer, this role serves as the primary coordinator for external audits—managing timelines, documentation, and responses while collaborating closely with internal teams, clients, and regulatory entities. Requires strong Medicare Advantage audit knowledge and project management skills to manage multiple audits concurrently. May also support enterprise-wide compliance program activities and projects as needed.

The External Audit Specialist works closely with internal operational teams, compliance leadership, health plan clients, and regulatory entities to help ensure timely, accurate, and organized audit responses in a highly regulated healthcare environment.

In addition to audit coordination responsibilities, the External Audit Specialist supports broader compliance operations and initiatives as workload permits, including policy management, audit/monitoring activities, reporting, training support, risk assessments, and special compliance projects.

Roles and Responsibilities

Essential Duties

• 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

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.
• 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.

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: All employees shall comply with company policies, including those related to security and privacy, as well as with applicable laws and regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, and other relevant federal and state regulations.

Data Protection: Employees are responsible for safeguarding protected health information (PHI) and personally identifiable information (PII) in accordance with company policies and HIPAA regulations. This includes ensuring that all data is accessed, processed, stored, and transmitted securely.

Note: 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.