Medicare Compliance & Audit Specialist

Verda Healthcare; Huntington Beach (CA); On-site; USD 72,000 - 85,000; Full time

Benefits offered by this job

401(k)

Paid time off

Health insurance

Dental Insurance

Vision insurance

Life insurance

Job summary

Verda Healthcare, Inc. is seeking a Compliance Analyst to support the Medicare Compliance Program, audits, and FDR oversight. This role focuses on CMS and state regulatory requirements, FWA prevention, and data-driven investigations.

The position reports to the AVP, Compliance and requires daily in-office attendance at our Huntington Beach, CA location. Full-time, with benefits including health, dental, vision, and 401(k).

Qualifications

• Bachelor’s degree in healthcare administration, business, public health, criminal justice, or a related field is required.
• At least 5 years of compliance, auditing, delegation oversight, or SIU/FWA experience within a health plan or MCO.
• Working knowledge of CMS Medicare Advantage and Part D requirements is preferred.
• Experience conducting audits, monitoring, and documenting findings with CAPs.

Responsibilities

• Conduct internal audits and routine monitoring of claims, utilization management, enrollment, and other areas per the annual plan.
• Develop audit tools, documents, and communicate results to owners and leadership.
• Prepare and track corrective action plans (CAPs) and oversee remediation.
• Support CMS program audits, state reviews, and delegation oversight of FDRs.
• Review delegate reports for timeliness, accuracy, and CMS contract compliance.
• Assist with FWA investigations, including data analysis and case documentation.

Skills

Auditing

Delegation oversight

SIU/FWA investigations

CMS Medicare Advantage knowledge

Education

Bachelor’s degree in healthcare administration, business, public health, criminal justice, or related field

Tools

Excel (Pivot tables)

Word

PowerPoint

SharePoint

Job description

Verda Healthcare, Inc. is seeking a Compliance Analyst to support the Medicare Compliance Program, audits, and FDR oversight. This role focuses on CMS and state regulatory requirements, FWA prevention, and data-driven investigations.

The position reports to the AVP, Compliance and requires daily in-office attendance at our Huntington Beach, CA location. Full-time, with benefits including health, dental, vision, and 401(k).