Strategic Healthcare Claims & Vendor Auditor

Johns Hopkins Health Plans; Washington (District of Columbia); On-site; USD 39,812 - 65,725; Full time

Job summary

Johns Hopkins Health Plans is seeking a Vendor Auditor to independently conduct claims and vendor performance audits, ensuring compliance with contracts, regulations, and quality standards. The role oversees high‑risk vendors, evaluates claims accuracy, and monitors remediation, producing reports and scorecards for leadership review.

The ideal candidate will have advanced knowledge of claims adjudication, Medicare/Medicaid reimbursement, and healthcare policies, with strong analytical and

Qualifications

• College Degree, preferred degree in Nursing, Accounting, Business, or Healthcare.
• Primary preference is a Nursing degree.
• Three (3) years of advanced claims auditing experience will be considered in lieu of college degree.

Responsibilities

• Conduct claims and vendor performance audits to ensure contractual and regulatory compliance.
• Manage day-to-day oversight of high-risk vendor population; evaluate claims accuracy and monitor performance.
• Analyze medical, pharmacy, and PBM claims data to assess payment accuracy and identify trends.
• Prepare formal audit reports; present findings to leadership and oversight committees.
• Monitor remediation efforts and maintain vendor performance scorecards.

Skills

Claims auditing

Data analysis

Vendor management

Regulatory compliance

Communication

Root cause analysis

Attention to detail

Education

Nursing degree preferred

College degree

Job description

Johns Hopkins Health Plans is seeking a Vendor Auditor to independently conduct claims and vendor performance audits, ensuring compliance with contracts, regulations, and quality standards. The role oversees high‑risk vendors, evaluates claims accuracy, and monitors remediation, producing reports and scorecards for leadership review.

The ideal candidate will have advanced knowledge of claims adjudication, Medicare/Medicaid reimbursement, and healthcare policies, with strong analytical and