Compliance Auditor - MAPD

Reporting to the Compliance Manager, MAPD Audit, you will contribute to the organization’s audit work plan, assess operational risk areas, and prepare audit findings that help guide regulatory readiness and operational improvement. This position calls for a strong foundation in CMS guidelines, managed care compliance, and effective collaboration with both internal teams and external partners.

In this role, you will:

• Conduct compliance audits related to operational functions, vendor performance, data validation, RADV, Triennial Review, pre-delegation reviews, and more.
• Design and improve audit toolkits based on Medicare Advantage and Part D risk areas.
• Collaborate with stakeholders and leadership to identify and address compliance risks.
• Maintain comprehensive documentation of audit activities and findings.
• Prepare detailed and professional audit reports for senior leadership and regulatory bodies.
• Support organization-wide audit readiness and regulatory preparedness.
• Coordinate external audits and ensure timely responses to agencies such as CMS or DMHC.
• Assist in training internal teams on compliance auditing procedures and best practices.
• Track and report compliance metrics, risk trends, and audit performance indicators.