Compliance Auditor, MAPD

Support compliance excellence at UCLA Health by joining our team as a Compliance Auditor, MAPD, focused on Medicare Advantage (Part C) and Prescription Drug (Part D) programs. In this vital role, you will conduct Risk Adjustment Data Validation (RADV) audits, compliance risk-based audits, support external audit coordination, and ensure alignment with CMS and DMHC regulations across the organization.

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.

Salary Range: $86,400- $184,800/annually

We're seeking a compliance professional with:

• Bachelor's degree in business administration, healthcare, or a related field and/or equivalent experience.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), highly desired.
• 5 or more years of experience in Medicare Advantage or Part D Managed Care environment.
• Hands-on experience conducting and leading RADV audits, highly desired.
• Strong understanding of CMS audit protocols, expectations, and regulations
• Experience participating in audits conducted by CMS and/or DMHC
• Ability to interpret and operationalize complex compliance guidance
• Excellent oral and written communication skills.
• Strong critical thinking and analytical abilities.
• Ability to lead or support compliance projects with minimal supervision.
• Proven track record of preparing professional, data-informed audit reports.
• Ability to work collaboratively across departments and functions in a fast-paced environment.
• High degree of integrity, attention to detail, and commitment to regulatory excellence.