Vendor Auditor

Johns Hopkins Health Plans; Washington (District of Columbia); In loco; USD 39.812 - 65.725; Tempo pieno

Descrizione del lavoro

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

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Claims auditing

Data analysis

Vendor management

Regulatory compliance

Communication

Root cause analysis

Attention to detail

Formazione

Nursing degree preferred

College degree

Descrizione del lavoro

Requisition #:672269 Location:Johns Hopkins Health Plans, Hanover, MD 21076 Category:Healthcare Operations Schedule:Day Shift Employment Type:Full Time

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.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.