Auditor II

Department: SHS MA Group Medicare S

Will this position be required to work onsite for any reason at any time? No

Engagement Description – Supports audit by retrieving, validating, and compiling documentation from claims systems to meet quality and deadline requirements. Partners with internal teams to respond to audit inquiries, resolve gaps, and ensure accurate submissions. Tracks and manages audit inquiries and deliverables, proactively identifying risks and ensuring timely completion. Conducts detailed claim reviews to validate audit samples and investigate errors. Determines appropriate documentation to support claim payments. Monitors implementation of corrective actions to ensure resolution. Communicates findings clearly, both verbally and in writing, and prepares and refines audit responses to ensure accuracy and clarity.

Top 3 Required Skills/Experience –
• Healthcare experience including claims/benefits
• Project/Workflow Coordination
• Communication Skills

Required Skills/Experience – The rest of the required skills/experience. Include:
• Healthcare experience including medical claims and Medicare Advantage product
• Strong knowledge of CMS rules and regulations
• Advanced Project Management
• Strong Communication Skills

Preferred Skills/Experience – Optional but preferred skills/experience. Include:
• Knowledge of IKA or NASCO claims processing systems
• Strong excel

Education/Certifications – Include:
• Bachelor's degree in Business Administration, Healthcare administration, Accounting, Finance or related field required.