Medicare Regulatory Audit Lead

EmblemHealth, Inc.; New York (NY); Remote; USD 78,000 - 149,000; Full time

Job summary

EmblemHealth in New York seeks a Senior Audit Lead to guide all external regulatory audits for Medicare Advantage, Part D, and state programs. You will plan, oversee data collection, and coordinate with regulators, internal SMEs, and cross-functional teams to deliver timely, accurate results.

The role requires 5–8+ years in healthcare audits, strong leadership, and excellent communication skills. Occasional travel to EmblemHealth facilities may be required, with a focus on minimizing business

Qualifications

• Bachelor’s Degree in a relevant field.
• 5–8+ years of professional work experience (Required).
• Healthcare industry experience with government audits (Required).
• Extensive knowledge of Medicare Advantage/Part D audits; HCC validation (Required).
• Experience managing external audit activities for CMS, HHS OIG, NYS agencies (Required).
• Excellent communication, leadership, and cross-functional collaboration skills (Required).

Responsibilities

• Lead and coordinate all phases of external regulatory audits.
• Plan, manage, and execute RADV and Part C&D audits.
• Coordinate regulators, internal SMEs, and cross-functional teams.
• Ensure timely remediation and minimal business disruption.
• Provide audit monitoring reports to CMS and leadership.
• Collaborate with Enrollment, Provider Operations, and related teams.
• Oversee vendor relationships and contract compliance.

Skills

Audit management

Regulatory compliance

Regulatory audits

Strong communication

Leadership

Education

Bachelor’s Degree

Tools

Microsoft Office

Job description

EmblemHealth in New York seeks a Senior Audit Lead to guide all external regulatory audits for Medicare Advantage, Part D, and state programs. You will plan, oversee data collection, and coordinate with regulators, internal SMEs, and cross-functional teams to deliver timely, accurate results.

The role requires 5–8+ years in healthcare audits, strong leadership, and excellent communication skills. Occasional travel to EmblemHealth facilities may be required, with a focus on minimizing business