Auditor, Provider Network (Medicare duals - MA State Health Plan)

Job description

Job Description: *******Employee for this role must reside in Massachusetts******* Job Summary: Provides audit support for contractual and regulatory compliance for specified providers in accordance with requirements established by state regulations. The role ensures provider adherence to applicable regulations through comprehensive audits, reviews, and investigations ensuring timely resolution and appropriate documentation. Analyzes audit results and compliance data to identify trends, risks, and recurring issues, and presents findings through written summaries, dashboards, and stakeholder-ready reporting to support regulatory readiness and continuous improvement. The position serves as a primary liaison between providers, internal departments, and regulatory agencies to support compliance, quality oversight, and regulatory readiness across the assigned territory. Job Duties: - Conducts outreach and schedule on-site and virtual meetings with specified providers within the assigned territory, including prospective and existing providers, in accordance with state requirements. - Analyze audit outcomes and compliance submissions to identify trends and risk signals (recurring deficien...