Audit Specialist II
About The Position
The Audit Specialist Analyst II is responsible for independently executing internal and external audits, interpreting audit findings, validating compliance with contractual performance guarantees, and supporting broader quality assurance initiatives. This role requires advanced knowledge of Affordable Care Act, Commercial, Medicare and Medicaid reimbursement methodologies, including facility, ancillary, and professional claims, as well as the ability to analyze claim calculations, interpret provider contracts, collaborate with cross-functional teams, and identify opportunities to improve audit accuracy, compliance, and operational performance.
Requirements
- Bachelor’s degree or equivalent experience in claims processing or audit.
- 2 years in audit or claims review.
- Familiarity with adjudication systems.
- Proficient in Microsoft Office and audit software.
- Strong analytical and communication skills.
Nice To Haves
- Experience in payment integrity or provider contracting – HIGHLY PREFERRED
- Extensive experience across ACA, Commercial, Medicare, and Medicaid plans, including reimbursement methodologies and payment structures
- Strong expertise in facility, ancillary, and professional billing, coding, and reimbursement practices
- Proven ability to interpret provider contracts and perform detailed claim reviews, calculations, and variance analysis
- Advanced analytical, critical thinking, and problem-solving skills to assess risks and recommend corrective actions
- Excellent communication and collaboration skills, with the ability to present findings, manage priorities independently, and partner effectively across stakeholders
Responsibilities
- Independently execute internal and external audits.
- Interpret audit findings.
- Validate compliance with contractual performance guarantees.
- Support broader quality assurance initiatives.
- Analyze claim calculations.
- Interpret provider contracts.
- Collaborate with cross-functional teams.
- Identify opportunities to improve audit accuracy, compliance, and operational performance.
Benefits
- Health and wellness benefits
- 401(k) savings plan
- Pension plan
- Paid time off
- Paid parental leave
- Disability insurance
- Supplemental life insurance
- Employee assistance program
- Paid holidays
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
