<p><strong>Job Title:</strong> Medical Claims Auditor - RN Auditor</p><p><strong>Location:</strong> Massachusetts – 90% Remote</p><p><strong>Job Type:</strong> 1 Year Contract - Potential for Perm Hire</p><p><strong>Hours:</strong> 40 hours per week</p><p><strong>Start Date:</strong> December 1, 2025</p><p><strong>Job Description</strong></p><p>We are seeking a qualified <strong>Auditor</strong> with healthcare experience to support Program Integrity activities for a state healthcare program. This role focuses on conducting both desk and onsite audits of healthcare providers to ensure compliance with contractual standards and regulatory requirements.</p><p> </p><p><strong>Responsibilities</strong></p><ul><li>Conduct audits (onsite and desk-based) of healthcare providers in alignment with state program guidelines</li><li>Travel locally as required to perform onsite audits (1-4 times per month)</li><li>Evaluate claims and provider documentation for compliance and accuracy</li><li>Collaborate with internal audit teams and leadership to maintain audit quality standards</li><li>Document findings and present audit outcomes clearly and effectively</li><li>Use Microsoft Office tools to manage reports, track audits, and communicate outcomes</li><li>Adhere to defined Service Level Agreements (SLAs) for audit completion and reporting</li></ul>

<p><strong>Required Qualifications</strong></p><ul><li><strong>3–5 years</strong> of experience in auditing, compliance, or claims analysis within a healthcare setting</li><li>Proficiency in <strong>Microsoft Office</strong> (Word, Excel, Outlook, etc.)</li><li>Ability to <strong>travel locally</strong> as needed</li><li>Strong analytical, organizational, and communication skills</li><li><strong>RN (Registered Nurse) </strong></li><li>Experience working in a <strong>Program Integrity</strong> role or similar environment is strongly preferred</li></ul><p><strong>Preferred Qualifications</strong></p><ul><li>Experience with <strong>MMQ/MDS assessments</strong></li><li>Background in <strong>claims and coding audits</strong></li><li>Strong presentation and stakeholder communication skills</li></ul><p><strong>Certifications & Licensing</strong></p><ul><li><strong>RN license</strong></li></ul><p><strong>Interview Process</strong></p><ul><li><strong>Rounds:</strong> 2</li><li><strong>Format:</strong> Phone interviews</li></ul><p><strong>How to Apply</strong></p><p>If you meet the qualifications and are interested in this opportunity, please submit your resume and a brief cover letter detailing your relevant experience.</p>

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