Healthcare Compliance Auditor (Medicare/Medicaid)

Neighborhood Health Plan of Rhode Island; Smithfield (RI); On-site; USD 60,000 - 90,000; Full time

Job summary

Neighborhood Health Plan of Rhode Island is seeking a Compliance Audit Specialist to participate in audits of internal departments and first-tier entities, evaluating controls and identifying gaps. You will create audit reports summarizing findings and corrective actions under the Manager of Compliance Audit.

The role requires a Bachelor’s degree and 2+ years in compliance, with knowledge of Medicare/Medicaid regulatory requirements and experience in auditing.

Qualifications

• Bachelor degree with emphasis in business, health administration or equivalent education and relevant work experience.
• Minimum of two or more years in the field of compliance.
• Knowledge of regulatory requirements related to Medicare/Medicaid programs.
• Ability to understand and implement health care regulations for managed care compliance.
• Experience with auditing, monitoring, and quality assurance.
• Strong business report writing skills and ability to document findings.

Responsibilities

• Participate in compliance audits to evaluate controls and adherence with applicable regulatory and contractual requirements.
• Identify and classify gaps as findings and observations; determine corrective actions.
• Review and assess policies, procedures, and samples for regulatory compliance.
• Track the status of audits and related deliverables.
• Assist the Manager in developing audit reports and annual audit plan.
• Help develop standard audit methodology and best practices.
• Perform other duties as assigned.

Skills

Bachelor's degree

2+ years compliance

Regulatory knowledge (Medicare/Medcaid

Healthcare regulations

Auditing/QA

Strong writing

Record keeping

MS Office proficiency

Independent work

Education

Bachelor's degree in business, health administration or equivalent

Tools

Microsoft Office

Job description

Neighborhood Health Plan of Rhode Island is seeking a Compliance Audit Specialist to participate in audits of internal departments and first-tier entities, evaluating controls and identifying gaps. You will create audit reports summarizing findings and corrective actions under the Manager of Compliance Audit.

The role requires a Bachelor’s degree and 2+ years in compliance, with knowledge of Medicare/Medicaid regulatory requirements and experience in auditing.