Medicare Advantage External Audit Specialist

Ram Technologies

7d•$78,000 - $88,000•Remote

About The Position

The Medicare Advantage External Audit Specialist supports external audits for Medicare Advantage, Part D, and SNP health plan clients nationwide. Reporting to the Chief Compliance Officer, this role serves as the primary coordinator for external audits—managing timelines, documentation, and responses while collaborating closely with internal teams, clients, and regulatory entities. Requires strong Medicare Advantage audit knowledge and project management skills to manage multiple audits concurrently. May also support enterprise-wide compliance program activities and projects as needed. The External Audit Specialist works closely with internal operational teams, compliance leadership, health plan clients, and regulatory entities to help ensure timely, accurate, and organized audit responses in a highly regulated healthcare environment. In addition to audit coordination responsibilities, the External Audit Specialist supports broader compliance operations and initiatives as workload permits, including policy management, audit/monitoring activities, reporting, training support, risk assessments, and special compliance projects.

Requirements

Bachelor’s degree or equivalent experience in healthcare administration, business administration, compliance, legal studies, public health, finance, or related field preferred.
Minimum of 2–5 years of experience in Medicare Advantage audit coordination or project management of CMS audits, delegation oversights, data validation audits, financial audits, and/or HIPAA audits.
Experience coordinating external audits, regulatory requests, or client oversight activities preferred.
Strong project coordination and organizational skills.
Excellent written and verbal communication abilities.
Ability to manage multiple priorities and deadlines simultaneously.
Strong follow-through, accountability, and time management skills.
Attention to detail and documentation accuracy.
Ability to interact professionally with regulators, auditors, clients, executives, and operational teams.
Proficiency with Microsoft Office Suite, including Excel, Word, PowerPoint, and Teams.

Nice To Haves

Compliance certification preferred, such as Health Care Compliance Association CHC, CHPC, CCEP, or similar

Responsibilities

Coordinate all aspects of external client, regulatory, and compliance audits involving Medicare Advantage, SNP, Part D, and Managed Medicaid plans and related healthcare operations.
Serve as the primary liaison between auditors, regulators, health plan clients, and internal operational departments.
Manage audit timelines, deliverables, evidence requests, and response tracking.
Coordinate collection, validation, organization, and submission of audit documentation and supporting evidence.
Schedule audit meetings, interviews, walkthroughs, and status updates with internal and external stakeholders.
Monitor audit progress and communicate status updates, risks, and deadlines to Chief Compliance Officer and Compliance Committee.
Track audit findings, corrective actions, remediation plans, and response due dates.
Assist with preparation for recurring CMS, client, and regulatory oversight activities.
Support internal compliance and vendor oversight audit activities.
Assist with compliance monitoring and oversight activities across operational areas.
Support policy and procedure review and maintenance activities.
Assist with issue tracking, investigations, and documentation management.
Participate in internal risk assessments and compliance reviews.
Support preparation of compliance reports, dashboards, presentations, and committee materials.
Maintain strict confidentiality of Protected Health Information (PHI), proprietary information, and sensitive client data.
Maintain awareness of applicable CMS Medicare Advantage regulations, guidance, and audit expectations.
Monitor regulatory changes impacting compliance operations and audit readiness activities.