Compliance Auditor

We are currently seeking a Medical Compliance Auditor to for a 6-month contract to hire position with our Long-Term Managed Care Client in Brooklyn, NY. 3+ experience of previous experience in Healthcare Auditing preferably in a Health Insurance Plan.

The Compliance Auditor will foster an environment that enhances and promotes compliance and adherence to all relevant federal, state, and local laws, rules and regulations applicable Part D, LHCSA and Article 28 requirements, etc., through audits. This role will integrate traditional audit functions with AI-specific compliance oversight, ensuring that AI systems, and automation tools align with legal, regulatory and internal policies.

The Compliance Auditor is responsible for performing internal and external auditing functions for the Compliance Department.

The Compliance Auditor applies advanced regulatory knowledge and analytical judgment to proactively conduct effective risk assessments and assist in preparing annual audit plan.

• - Assist in conducing enterprise-wide risk assessments and actively contribute to the development and execution of the annual compliance audit plan.
• - Design and implement comprehensive, risk-based audit programs to assess compliance with governmental, contractual, and regulatory requirements.
• - Perform independent audits and monitoring activities in accordance with the approved audit plan, ensuring appropriate scope, testing, and documentation.
• - Identify root causes, and systemic compliance risks; clearly document observations and support findings with defensible evidence.
• - Communicate audit results effectively, using data and analysis to support conclusions and recommendations.
• - Partner with operational leaders to develop, track, and validate corrective action plans, ensuring timely and sustainable remediation.
• - Monitor audit outcomes and trends, reporting progress and residual risk to compliance leadership and governance as appropriate.
• - Maintain high-level knowledge of applicable laws, regulations, and guidance, and provide targeted education and advisory support to management and stakeholders.
• - Serve as a compliance resource by being accessible, collaborative, and solution-oriented.
• - Conduct site visits to all out sites with locations in the five boroughs of NYC, Westchester and Long Island.
• - Use AI-assisted audit tools to automate evidence collection, workflow management, and report drafting.
• - Conduct AI-specific compliance audits to assess accuracy and regulatory alignment of operational reporting.
• - Perform additional duties as assigned in alignment with the goals, and responsibilities of the Compliance Department.

Education:

Bachelor's degree in health care administration, political science, social science or related field required.

• - Minimum of three (3) years Healthcare Audit background preferably in a Health Insurance Plan
• - Understanding of Medicare and Medicaid programs is strongly preferred.
• - An in-depth understanding of the industry's rules, guidelines, and regulations.
• - Billing and Coding experience, preferred.
• - Strong attention to detail, analytical, and statistical skills.

Please note:

This position is not open to 3rd party c2c agencies. No visa sponsorship provided. All applicants must have permanent US work authorization and not require sponsorship now or in the future.