Audit Specialist (Monitoring, Compliance, Quality and Program Integrity)Neil Hoosier & Associates, Inc. • (Multiple States), US
Audit Specialist (Monitoring, Compliance, Quality and Program Integrity)
Neil Hoosier & Associates, Inc. • (Multiple States), US
4 days ago
Job type
- Full-time
- Quick Apply
Job descriptionThe following reflects management’s definition of essential functions for this job but does not restrict the tasks that may be assigned. Management reserves the right to assign or reassign responsibilities, as necessary. Support the design, documentation, and implementation of a Monitoring Plan and Standard Operating Procedures (SOPs) for compliance and law enforcement screening activities. Identify, evaluate, and document key risks and compliance requirements, focusing on protecting beneficiaries, adherence to CMS agreements, and compliance with federal regulations. Collaborate with key stakeholders to map monitoring and compliance activities (e.g., audits, data analysis, and ongoing reviews) to program goals and risk areas. Contribute to methodologies for risk profiling, reporting, and lessons learned to promote continuous improvement in compliance and oversight activities. Conduct comprehensive annual audits and ad hoc audits to assess compliance with Participation Agreement provisions, prior authorization processes, and technology requirements. Perform data-driven analyses of participant-submitted data, claims, and quality outcomes to identify trends, outliers, and potential risks affecting beneficiary safety and program compliance. Verify participant adherence to timelines, data accuracy, and procedural requirements through review of submitted documentation and system data. Support virtual and document-based audit processes, including notifications, sampling strategy development, audit execution, scoring, and follow-up activities. Support quarterly CPI and law enforcement screenings and associated personnel using databases such as APS, PECOS, OnePI, and Do Not Pay (DNP). Prepare participant data lists, interpret screening results, and make recommendations for remedial actions in collaboration with CMS. Conduct environmental scanning to identify potential legal or conflict-of-interest (COI) concerns and assess program integrity implications. Maintain documentation of noncompliant participants and track corrective and preventive actions. Assist CMS and the project team in determining risk levels (low, moderate, high) for noncompliance findings. Recommend and support the implementation of remedial actions including corrective action plans (CAPs), noncompliance notifications, education and outreach, and other enforcement steps as appropriate. Maintain compliance history, audit findings, and participant-level risk ratings. Support structured lessons learned processes following monitoring and audit activities to improve future program performance and standardization. Develop and deliver quarterly monitoring and audit reports, summarizing compliance findings, key metrics, and recommended actions for CMS. Ensure findings are presented clearly and consistently using visual and narrative formats for CMS leadership and program stakeholders. Contribute to the creation and maintenance of remedial action and monitoring documentation within CMS-approved systems (e.g., SharePoint, Model Space). Support CMS engagement and communications through professional correspondence, technical assistance, and compliance education. Bachelor’s degree in healthcare administration, public health, compliance, auditing, data analytics, or related field 3-5 years of Fee-For-Service (FFS) CMS experience in healthcare compliance, auditing, or federal program integrity initiatives Demonstrated experience conducting risk-based audits, compliance reviews, quality audits, and data analysis within federal healthcare programs or contractor environments. Proficiency with audit management systems, Excel, and data analytics tools (e.g., SAS, SQL, R, or Python) preferred Familiarity with Medicare and Medicaid policies, CMS Innovation Center models, and prior authorization regulations (including CMS-0057-F), preferred. Experience working with provider screening systems (APS, PECOS, OnePI) and compliance databases (DNP, LEIE) preferred. Ability to synthesize complex regulatory information into actionable audit findings and reports. Commitment to integrity, accuracy, and confidentiality in all compliance activities. Excellent communication and stakeholder engagement skills to support collaborative compliance management. Versatility, flexibility, and willingness to work within constantly changing priorities Strong interpersonal skills NHA is a state and federal government contractor; all employees must be legally authorized to work in the United States. NHA does not provide sponsorship at this time. NHA is an Equal Employment Opportunity employer. Powered by JazzHR
Pay Range :
- $79K – 83K based on experience Summary : NHA is seeking an Audit Specialist to support Centers for Medicare & Medicaid Services’ (CMS) initiative designed to tackle fraud, waste and abuse (FWA) in Medicare Fee-for-Service (FFS) by using advanced technologies. The Audit Specialist will play a key role in ensuring program integrity, compliance, monitoring and quality in support of a comprehensive, data-driven monitoring program designed to safeguard model integrity, ensure adherence to regulatory and technological standards, and reduce risk to CMS and its beneficiaries.
Responsibilities and Duties :
Qualifications :
Salesforce experience Experience with MS Teams, Sharepoint, MS Suite Experience using and applying Artificial Intelligence (AI) in the workplace Strong analytical, writing, and organizational skills.
All qualified applicants will receive consideration for employment based on merit, without regard to race, color, religion, sex, sexual orientation, national origin, veteran status, disability or any other basis protected by law.
Create a job alert for this search
Compliance Specialist • (Multiple States), US
Related jobs
This Jobot Job is hosted by : Jerry Sipocz.Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resume.
Salary : $85,000 - $115,000 per year.Our client is a well-establ...Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...Show more
Why work for Cura Hospitality?.We share an appetite for growth which drives all of us to continually reimagine our customers’ experience.
We are looking to add an experienced .Part-Time C...Show more
PRN / Pool positions - Weekday and Weekend options available.Appreciated for your Dietitian Skills.Are you a dedicated dietitian in search of a career that feels close to home and heart? As a dietiti...Show more
Apply (by clicking the relevant button) after checking through all the related job information below.POSITION SUMMARY / RESPONSIBILITIES.
The Senior Clinical Research Coordinator leads the evaluation ...Show more
Read on to find out what you will need to succeed in this position, including skills, qualifications, and experience.TX232 : Richardson 1727 CityLine 1727 East CityLine Drive Building C27, Richardso...Show more
Customs and Border Protection (CBP) offers those interested in a career in law enforcement an exceptional opportunity to work with an elite team of highly trained professionals whose camaraderie, p...Show more
The Good Life MedStaff is seeking a travel Physical Therapist for a travel job in Independence, Kansas.Job Description & Requirements.
Southeast Kansas Outpatient Clinic in need of a Physical Therap...Show more
We are seeking a Funds Control Specialist in office full-time to join our team in Southpointe (Canonsburg, PA).If you want to know about the requirements for this role, read on for all the relevant...Show more
SOC 2 Audit Manager Department : .Technical Advisory & Consultancy (TAC) Type : Full-Time (US-Based) Location : Remote Pay : Based on experience, education, location, and market rates Travel : 1̵...Show more
England is Now Hiring CDL-A OTR Drivers!.Drivers Average $62,504 Annually •.A valid CDL-A and 3+ months of current experience are required.
This lane is not suitable for students, recent grads, or tr...Show more
DoorDash is the #1 category leader in food delivery, food pickup, and convenience store delivery in the US, trusted by millions of customers every day.
As a Dasher, you’ll stay busy with a variety o...Show more Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.
We guarantee 15-25 hours per week with an hourly pay of bet...Show more 
Kansas (US-KS) Why work for Cura Hospitality?.No Late-Night Shifts! Weekly Pay! Advancement Opportunities! Work / Life Balance! Employee Referral Program! And Much More! Elior North America.We share ...Show more
Sign-On Bonus Available with Certificate.Compensation for this role is based on a number of factors, including but not limited to experience, education, and other business and organizational consid...Show more
If you think you are the right match for the following opportunity, apply after reading the complete description.MRBRAZ and Associates, PLLC is seeking an individual with at least 3 years of work e...Show more
A well-respected CPA firm in the area is looking to add an.This stable and growing firm offers their clients valuable knowledge and expertise in tax and audit work.
Due to the recent growth of the f...Show more Remember to check your CV before applying Also, ensure you read through all the requirements related to this role.POSITION SUMMARY / RESPONSIBILITIES.
The Senior Trauma Outcomes Coordinator must posse...Show more
Senior Audit Associate
Jobot • US
Permanent
Last updated: 2 days ago • Promoted
Test Products from Home – $25-$45 / hr + Freebies
OCPA • Nowata, Oklahoma, us
Part-time +1
Last updated: 30+ days ago • Promoted
Part-Time Registered Dietitian
Cura-Hospitality • Sycamore, KS, US
Part-time
Last updated: 11 days ago • Promoted
Dietitian
Ascension St. John Rehabilitation Hospital, an affiliate of Encompass Health - Owasso • Nowata, OK, US
Full-time +1
Last updated: 26 days ago • Promoted
Lead Research Compliance Specialist (HONDO)
University Health • US
Full-time
Last updated: 15 days ago • Promoted
Senior Systems Integration and Test Engineer
Raytheon • US
Full-time
Last updated: 1 day ago • Promoted
Customs and Border Protection Officer
U.S. Customs and Border Protection • Independence, Kansas, US
Full-time +1
Last updated: 30+ days ago • Promoted
Travel Physical Therapist - $2,676 per week
The Good Life MedStaff • Independence, KS, United States
Full-time
Last updated: 21 days ago • Promoted
Funds Control Specialist
CFAS, LLC • US
Full-time
Last updated: 6 days ago • Promoted
SOC 2 Audit Manager
RSI Security • (Multiple States), US
Full-time
Quick Apply
Last updated: 30+ days ago
CDL-A OTR Truck Driver - Average $62,504 / Year - 3 Months Experience
C.R. England • Nowata, OK, US
Full-time
Last updated: 30+ days ago • Promoted
Restaurant Delivery - Sign Up and Start Earning
DoorDash • Neodesha, US
Full-time +1
Last updated: 8 hours ago • Promoted • New!
Product Tester (Work From Home) – Keep Free Products + Weekly Pay
OCPA • Nowata, Oklahoma, us
Remote
Part-time +1
Last updated: 30+ days ago • Promoted
Part-Time Registered Dietitian
CURA Hospitality • Cherryvale, Kansas, United States
Part-time
Last updated: 5 hours ago • Promoted • New!
PEER RECOVERY SPECIALIST CERTIFIED
University of New Mexico - Hospitals • US
Full-time
Last updated: 7 hours ago • Promoted • New!
Automation Controls Specialist
MRBraz & Associates, PLLC • US
Full-time
Last updated: 7 hours ago • Promoted • New!
Audit Senior
Gpac • United States, United States, United States
Full-time
Quick Apply
Last updated: 30+ days ago
Trauma Quality Improvement Specialist (SAN ANTONIO)
University Health • US
Full-time
Last updated: 30+ days ago • Promoted