Claims Audit Manager (Hybrid)
LiveWell Centers
Date: 3 weeks ago
City: Philadelphia, PA
Contract type: Full time
Claims Audit Manager - Healthcare Compliance
Job Type: Full-Time
We’re seeking a detail-oriented and experienced Claims Audit Manager to lead and manage pre- and post-payment audits across our healthcare facilities. This role plays a critical part in ensuring regulatory compliance and minimizing financial risk through accurate audit execution and reporting.
What You’ll Do
EEO
Job Type: Full-Time
- Hybrid
We’re seeking a detail-oriented and experienced Claims Audit Manager to lead and manage pre- and post-payment audits across our healthcare facilities. This role plays a critical part in ensuring regulatory compliance and minimizing financial risk through accurate audit execution and reporting.
What You’ll Do
- Manage all aspects of claims audits, including CMS, TPE, Medicaid, Medicare, and Managed Care audits
- Collect and prepare comprehensive audit documentation
- Communicate directly with facility teams and external auditors to resolve issues
- Facilitate onsite visits as needed to support audit activities
- Ensure timely and accurate submission of all audits
- Track audit outcomes, identify trends, and initiate corrective action plans
- Maintain strong relationships with internal and external stakeholders
- Monitor regulatory changes and incorporate best practices
- Recommend process improvements to enhance compliance and efficiency
- MDS experience required (LNAC or RNAC strongly preferred)
- Prior experience in claims auditing or healthcare compliance
- In-depth knowledge of Medicare, Medicaid, Managed Care, and CMS audit regulations
- Strong analytical, organizational, and communication skills
- Ability to work independently, manage multiple audits, and meet deadlines
- Comfortable with occasional travel to facility sites
- Be part of a dedicated, mission-driven healthcare organization
- Support compliance efforts that directly impact patient care quality
- Competitive salary and benefits package
- Opportunities for growth and continued professional development
EEO
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