Healthcare Audit & Compliance Specialist

Position Title: Healthcare Audit & Compliance Specialist

Location: Birmingham, AL

Position Status: Contract

Position Description:

We are seeking a detail-oriented and proactive Healthcare Audit & Compliance Specialist to manage and support external commercial payer audits while helping ensure organizational compliance with regulatory and payer requirements. This role serves as a key partner to Revenue Cycle, Compliance, HIM, Billing, and Operational teams, coordinating audit activities, facilitating appeals, and driving successful audit outcomes.

The ideal candidate is highly organized, analytical, and skilled at navigating complex healthcare audit processes. If you enjoy problem-solving, collaborating across teams, and making a measurable impact on compliance and revenue integrity, we'd love to hear from you.

Key Responsibilities

External Audit Management

• Manage assigned commercial payer audits through the full audit lifecycle, including intake, review, documentation collection, submission, determination, appeals, and closure.
• Analyze audit requests to identify documentation requirements, scope, deadlines, payer criteria, and regulatory considerations.
• Coordinate timely responses and submissions to ensure compliance with payer and audit requirements.
• Track audit status, outcomes, financial impact, and appeal activity, providing regular reporting to leadership.

Appeals & Resolution

• Prepare, coordinate, and submit audit appeals supported by appropriate clinical, coding, billing, and regulatory documentation.
• Monitor appeal determinations and audit findings, ensuring timely follow-up and escalation when needed.
• Partner with stakeholders to support successful audit resolutions and maximize reimbursement opportunities.

Compliance & Process Improvement

• Ensure audit-related activities align with organizational policies, payer guidelines, regulatory requirements, and compliance standards.
• Maintain accurate audit inventories, records, and reporting tools.
• Identify trends, risks, and opportunities to improve audit outcomes and operational processes.
• Contribute to policy development, workflow optimization, and continuous improvement initiatives.

Collaboration

• Work closely with Revenue Cycle, Compliance, Coding, Billing, Clinical Operations, and other internal stakeholders to gather and validate supporting documentation.
• Communicate audit findings, risks, and recommendations clearly to management and cross-functional teams.

Qualifications

Required

• Bachelor's degree in Healthcare Administration, Business, Finance, Compliance, or a related field; or an equivalent combination of education and relevant experience.
• Minimum 2 years of experience in healthcare compliance, audit management, revenue cycle operations, payer audits, appeals, or a related healthcare function.
• Strong analytical, problem-solving, and organizational skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and deadlines in a fast-paced environment.

Preferred

• Experience supporting commercial payer audits, reimbursement reviews, or payment integrity audits.
• Knowledge of healthcare regulations, payer policies, documentation requirements, and audit methodologies.
• Revenue Cycle Management (RCM) experience.
• Experience with audit tracking, case management, or reporting systems.
• Advanced proficiency in Microsoft Excel, including data analysis and reporting.
• Familiarity with healthcare billing, coding, claims review, denials management, or appeals processes.

About Seneca Resources:

At Seneca Resources, we are more than just a staffing and consulting firm, we are a trusted career partner. With offices across the U.S. and clients ranging from Fortune 500 companies to government organizations, we provide opportunities that help professionals grow their careers while making an impact.

When you work with Seneca, you’re choosing a company that invests in your success, celebrates your achievements, and connects you to meaningful work with leading organizations nationwide. We take the time to understand your goals and match you with roles that align with your skills and career path. Our consultants and contractors enjoy competitive pay, comprehensive health, dental, and vision coverage, 401(k) retirement plans, and the support of a dedicated team who will advocate for you every step of the way.