Compliance Specialist, Accounting

To perform internal audits to ensure regulatory compliance in an assigned area. To support the management and resolution of external commercial payor audits by coordinating audit requests, reviewing findings, facilitating payer communications, preparing appeals, tracking outcomes, and ensuring timely completion of audit activities.

• Manages assigned external commercial payor audits throughout the audit lifecycle, including intake, review, tracking, submission, determination, appeal, and closure activities. Reports results to upper management.
• Reviews audit requests to determine documentation requirements, deadlines, scope of review, and applicable payer guidelines.
• Monitors appeal status and payer determinations to ensure timely follow-up, escalation, and resolution of outstanding audit cases.
• Coordinates with internal stakeholders to obtain supporting medical and billing documentation necessary for audit responses and appeals.
• Ensures audit activities are handled in accordance with organizational policies, payer requirements, regulatory standards, and established audit management procedures.
• Maintains accurate audit inventories and tracking logs, documenting status, outcomes, financial impact, and appeal activity.
• Assists with audit-related process improvement initiatives and policy development.
• Performs other duties as assigned.

Bachelor's degree in a related field and two (2) years of related experience preferred. Equivalent combinations of education, relevant healthcare audit, revenue cycle, compliance, or appeals experience will be considered.

• Experience with audit tracking and reporting tools.
• Strong analytical, organizational, and communication skills.
• Proficiency with Microsoft Excel and audit tracking tools.