Healthcare Vendor Auditor & Claims Compliance

Johns Hopkins Medicine; Maryland; Presencial; USD 39.812 - 65.725; Jornada completa

Descripción de la vacante

Johns Hopkins Medicine seeks a Vendor Auditor to independently audit claims and vendor performance, ensuring contracts, SLAs, and regulatory standards are met. The role focuses on evaluating claims accuracy across medical, pharmacy, and PBM data and monitoring remediation efforts with leadership involvement.

The ideal candidate will have advanced claims auditing expertise, familiarity with Medicare/Medicaid reimbursement, authorizations, and appeals, plus strong analytical and collaborative

Formación

• College degree required; nursing degree preferred; other healthcare degrees acceptable.
• Three years of advanced claims auditing experience can substitute for degree.

Responsabilidades

• Conduct claims and vendor performance audits to ensure contractual and regulatory compliance.
• Analyze medical, pharmacy, and PBM claims data to assess payment accuracy.
• Perform root cause analysis of identified trends and discrepancies.
• Review vendor contracts and SLAs; monitor remediation and scorecards.

Conocimientos

Claims adjudication

Medicare/Medicaid reimbursement

Authorizations

Appeals

Healthcare reimbursement policies

Educación

College degree

Descripción del empleo

Johns Hopkins Medicine seeks a Vendor Auditor to independently audit claims and vendor performance, ensuring contracts, SLAs, and regulatory standards are met. The role focuses on evaluating claims accuracy across medical, pharmacy, and PBM data and monitoring remediation efforts with leadership involvement.

The ideal candidate will have advanced claims auditing expertise, familiarity with Medicare/Medicaid reimbursement, authorizations, and appeals, plus strong analytical and collaborative