Claims Audit Manager (Hybrid)

Claims Audit Manager - Healthcare Compliance

Job Type: Full-Time

• Hybrid
  
  
  

About The Role

We’re seeking a detail-oriented and experienced Claims Audit Manager to lead and manage pre- and post-payment audits across our healthcare facilities. This role plays a critical part in ensuring regulatory compliance and minimizing financial risk through accurate audit execution and reporting.

What You’ll Do

• Manage all aspects of claims audits, including CMS, TPE, Medicaid, Medicare, and Managed Care audits
• Collect and prepare comprehensive audit documentation
• Communicate directly with facility teams and external auditors to resolve issues
• Facilitate onsite visits as needed to support audit activities
• Ensure timely and accurate submission of all audits
• Track audit outcomes, identify trends, and initiate corrective action plans
• Maintain strong relationships with internal and external stakeholders
• Monitor regulatory changes and incorporate best practices
• Recommend process improvements to enhance compliance and efficiency
  
  
  

What You Bring

• MDS experience required (LNAC or RNAC strongly preferred)
• Prior experience in claims auditing or healthcare compliance
• In-depth knowledge of Medicare, Medicaid, Managed Care, and CMS audit regulations
• Strong analytical, organizational, and communication skills
• Ability to work independently, manage multiple audits, and meet deadlines
• Comfortable with occasional travel to facility sites
  
  
  

Why Join Us?

• Be part of a dedicated, mission-driven healthcare organization
• Support compliance efforts that directly impact patient care quality
• Competitive salary and benefits package
• Opportunities for growth and continued professional development
  
  
  

Apply today to help us strengthen our audit and compliance framework while making a meaningful impact in healthcare!

EEO