Claims Audit Manager (Hybrid)

LiveWell Centers; Philadelphia (Philadelphia County); Hybrid; USD 75,000 - 113,000; Full time

Job summary

An innovative healthcare organization is seeking a Claims Audit Manager to lead and manage audits across various facilities. This role is pivotal in ensuring compliance and minimizing financial risks through meticulous audit execution. You will collaborate with facility teams and external auditors, monitor regulatory changes, and drive process improvements. Join a mission-driven team where your expertise will directly impact patient care quality and contribute to a supportive healthcare environment. This position offers competitive compensation and opportunities for professional growth.

Benefits

Competitive salary

Benefits package

Opportunities for growth

Professional development

Qualifications

• Detail-oriented with experience in managing claims audits across healthcare facilities.
• In-depth knowledge of Medicare, Medicaid, and CMS audit regulations.

Responsibilities

• Manage aspects of claims audits and ensure regulatory compliance.
• Track audit outcomes and recommend process improvements.

Skills

Claims Auditing

Healthcare Compliance

Analytical Skills

Organizational Skills

Communication Skills

Education

MDS Experience (LNAC or RNAC preferred)

Experience in Claims Auditing

Job description

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Claims Audit Manager - Healthcare Compliance

Job Type: Full-Time

• Hybrid
  
  
  

About The Role

We’re seeking a detail-oriented and experienced Claims Audit Manager to lead and manage pre- and post-payment audits across our healthcare facilities. This role plays a critical part in ensuring regulatory compliance and minimizing financial risk through accurate audit execution and reporting.

What You’ll Do

• Manage all aspects of claims audits, including CMS, TPE, Medicaid, Medicare, and Managed Care audits
• Collect and prepare comprehensive audit documentation
• Communicate directly with facility teams and external auditors to resolve issues
• Facilitate onsite visits as needed to support audit activities
• Ensure timely and accurate submission of all audits
• Track audit outcomes, identify trends, and initiate corrective action plans
• Maintain strong relationships with internal and external stakeholders
• Monitor regulatory changes and incorporate best practices
• Recommend process improvements to enhance compliance and efficiency
  
  
  

What You Bring

• MDS experience required (LNAC or RNAC strongly preferred)
• Prior experience in claims auditing or healthcare compliance
• In-depth knowledge of Medicare, Medicaid, Managed Care, and CMS audit regulations
• Strong analytical, organizational, and communication skills
• Ability to work independently, manage multiple audits, and meet deadlines
• Comfortable with occasional travel to facility sites
  
  
  

Why Join Us?

• Be part of a dedicated, mission-driven healthcare organization
• Support compliance efforts that directly impact patient care quality
• Competitive salary and benefits package
• Opportunities for growth and continued professional development
  
  
  

Apply today to help us strengthen our audit and compliance framework while making a meaningful impact in healthcare!

EEO

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Hospitals and Health Care

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