Vendor Auditor

Johns Hopkins Medicine; Maryland; On-site; USD 39,812 - 65,725; Full time

Job summary

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

Qualifications

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

Responsibilities

• 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.

Skills

Claims adjudication

Medicare/Medicaid reimbursement

Authorizations

Appeals

Healthcare reimbursement policies

Education

College degree

Job description

Position Summary

Under the general supervision of the Department Director, the Vendor Auditor is responsible for independently conducting claims and vendor performance audits to ensure compliance with contractual obligations, regulatory requirements, and Johns Hopkins Health Plans' quality standards. This position manages the day-to-day oversight of the organization's highest-risk vendor population by evaluating claims accuracy, monitoring vendor performance, identifying operational risks, and recommending corrective actions.

The Vendor Auditor analyzes medical, pharmacy, and PBM claims data to assess payment accuracy, performs root cause analysis of identified trends and discrepancies, and reviews vendor compliance with contracts and Service Level Agreements (SLAs). This role prepares formal audit reports, presents findings to leadership and oversight committees, monitors remediation efforts, and maintains vendor performance scorecards.

The ideal candidate possesses advanced knowledge of claims adjudication, Medicare and Medicaid reimbursement, authorizations, appeals, and healthcare reimbursement policies. Success in this role requires exceptional analytical, critical thinking, communication, and interpersonal skills, along with the ability to work independently, manage multiple priorities, and effectively collaborate with internal stakeholders and external vendors to promote continuous quality improvement.

Requirements:

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.

Salary Range: Minimum 28.90/hour - Maximum 47.71/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.