AUDIT ANALYST JOB DESCRIPTION

An Audit Analyst in healthcare reviews operational activities, clinical documentation, and billing records to verify that charges, claims, and compliance obligations are accurately met. The role sits within internal audit or compliance functions, answering to department leadership and working alongside clinical teams, revenue cycle staff, and third-party reviewers. Errors go undetected without it. Healthcare audit work is shaped by federal and state regulatory frameworks including Medicare and Medicaid reimbursement rules and EMTALA requirements, meaning the Audit Analyst must translate dense policy into operational findings that departments can act on.

As the Audit Analyst, you drive the accuracy and integrity of healthcare claims, billing, and compliance documentation by executing structured audit programs and delivering findings that prevent financial loss and regulatory exposure. You work within an internal audit or compliance department, collaborating with revenue cycle leadership, clinical department managers, and legal or risk management teams to close gaps and standardize audit practices.

Career Impact: Sustained work in healthcare compliance auditing builds recognized expertise in Medicare and Medicaid billing regulations, a credential that commands consistent demand across hospital systems, payers, and government contractors.

Business Impact: The findings this role produces directly prevent incorrect claim payments, reduce third-party audit exposure, and protect patient rights documentation from compliance gaps that carry financial and legal consequences.

Growth Opportunity: Audit Analysts who develop root cause analysis and revenue cycle knowledge are well positioned to advance into roles such as Audit Manager or Compliance Director, where program ownership replaces individual testing.

• Audit claims, billing records, and operational activities to verify accuracy and prevent incorrect payments.
• Identify and document internal errors, fraudulent expenses, and suspicious activity for escalation to designated investigation teams.
• Conduct root cause analyses on audit findings and translate results into actionable recommendations for department leadership.
• Develop and distribute regular audit reports to operations staff, department managers, and senior leadership.
• Collaborate with clinical departments, revenue cycle teams, and training staff to assess compliance gaps and determine corrective actions.
• Review medical records against itemized bills to verify charge documentation and identify charging inaccuracies.
• Assist with third-party audit responses by validating selected claims, completing questionnaires, and addressing identified errors.
• Monitor policy compliance areas and report high-risk findings, including overdue reviews or ownership gaps, to the director of record.

• Bachelor's degree in Health Administration, Accounting, Business, Finance, or equivalent work experience.
• 2 or more years of experience in healthcare auditing, medical claims processing, or revenue cycle compliance, with direct exposure to billing or charge reconciliation.
• Knowledge of Medicare, Medicaid, and third-party payer billing and reimbursement regulations.
• Familiarity with healthcare compliance frameworks including EMTALA requirements and patient rights documentation standards.
• Ability to organize, prioritize, and manage multiple audit workstreams independently while meeting established schedules.
• Strong written and verbal communication skills, with the ability to present findings clearly to clinical and administrative stakeholders.
• Proficiency in spreadsheet and document management tools for audit documentation, report preparation, and data tracking.

• Experience in revenue cycle functions with specific emphasis on charge reconciliation, coding, or hospital billing operations.
• Quality assurance or process improvement certification such as Lean, Six Sigma, or a recognized QA credential.
• Exposure to international claims processing or multi-payer audit environments.
• Prior participation in policy committee work, third-party audit coordination, or compliance documentation administration.

• Audit completion rate against scheduled review calendar, measured monthly.
• Error identification rate per audit cycle, reflecting detection of incorrect payments and charge inaccuracies.
• Third-party audit response turnaround time, measured in days from request to submission.
• Percentage of high-risk compliance findings escalated and resolved within agreed remediation windows.
• Root cause findings translated into documented corrective action plans per quarter.
• Typical tools: audit and compliance management platforms (commonly PolicyTech or equivalent); spreadsheet and reporting tools (commonly Excel or equivalent).

• Base Salary Range: $55,000 to $80,000 annually, depending on experience and market.
• Bonus: Annual performance bonus typically 5 to 10 percent of base salary.
• Equity: Equity not standard for this role in healthcare settings.
• Health Benefits: Medical, dental, and vision coverage; employer contribution common.
• PTO: 15 to 20 days annually plus standard federal holidays.
• Common Perks: Continuing education support, certification reimbursement, and EAP access.

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Successful completion of a background check and, where applicable, a drug screening is a condition of employment. All qualified applicants are considered without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations are available to individuals with disabilities throughout the application and employment process upon request. Candidates must be authorized to work in the United States.

The Audit Analyst owns the execution of Internal Audit testing programs at New American Funding, ensuring compliance with TRID requirements, Federal and State regulations, and internal policies across discretionary, special, and required audits. Working closely with the Internal Audit Manager and Business Owners, the Audit Analyst delivers findings documentation and monthly reporting that supports management's audit objectives and schedule.

Key Responsibilities

• Perform discretionary, special, and required audits.
• Work within the audit team to meet management's objectives and audit schedules.
• Ensure all audit findings are properly documented and escalated to management as needed.
• Recommend changes to testing procedures based on completed findings if needed.
• Maintain awareness of changes to regulatory (TRID), operational, and investor guidelines.
• Participate in company-sponsored training events to further develop industry knowledge and business lending requirements.
• Participate in the consolidation and distribution of various reports within the Internal Audit Department.
• Participate in the monthly reporting of audit/test findings with Business Owners, Department Managers, and Senior Management staff.
• Assist the Internal Audit Manager with development of additional audit/testing projects as needed.

Required Qualifications

• Bachelor's Degree or equivalent business experience.
• Robust mortgage industry experience is highly desirable.
• Encompass experience preferred.
• Proficient with Microsoft Office Products (Excel, Word, Outlook, PowerPoint).
• Ability to handle multiple projects if needed.
• Strong business acumen with ability to work with people of diverse backgrounds.
• Ability to build relationships across the organization.
• Ability to work within a team environment as well as independently.
• Effective written and oral communicator with strong listening skills.

Reporting to audit leadership, the Internal Audit Analyst shapes planning and execution of operational, regulatory, and IT compliance audits across the Highmark Health Enterprise, including identification of key risks, control testing, and audit report development. Partnering with entry-level staff, independent auditors, and subject matter experts, the Internal Audit Analyst strengthens the organization's control environment and drives process improvement recommendations.

Primary Duties

• Collaborate with team members to perform planning activities for operational, regulatory, and IT compliance audits, including identification of key risks and controls, development of audit programs, timelines, and planning documents.
• Plan and execute testing of mid-level controls, process-level manual controls, IT dependent manual controls, and process-level automated application controls.
• Manage the close-out and finalization of audits and projects, including issue assessment, audit report development, and review of documentation and work papers per departmental standards.
• Act as a resource for entry-level staff by fostering a positive working environment, monitoring workloads, and adjusting assignments to promote work/life quality while meeting client expectations.
• Effectively communicate with customers, supervisors, and subject matter experts to deliver requests on time and ensure clarity on project status and deliverables.
• Collaborate with team and independent auditors to execute audit procedures, evaluate business process and IT controls, and identify recommendations for process improvements and operational efficiencies.
• Perform other duties as assigned.

Education & Experience

• Bachelor's Degree in Accounting, Finance, Business Administration, Information Systems, or related field.
• CPA, CIA, CFE, or CISA certification.
• 2 years in Public Accounting, Internal Auditing, Internal Control Design/Documentation or testing, or a comparable Corporate Finance role.
• Knowledge of internal audit functions including GAAS, GAAP, and industry standards applicable to operational, financial, and compliance audits.
• Effective resource and project planning, decision making, results delivery, and team building skills.
• Effective written and oral communication skills with the ability to establish business relationships and develop solutions with a client-based focus.
• Self-starter with ability to work independently and under pressure as part of a team, think strategically, and build trust with business units.

Sitting at the intersection of compliance and operational integrity, the Audit Analyst reviews the accuracy of claims activities, identifies errors and fraudulent expenses, and submits suspicious findings to internal investigation teams. Operating across multiple departments, the Audit Analyst enables safeguard development and produces regular audit reports that protect the organization and its customers from financial and regulatory risk.

Duties

• Audit and review the accuracy of operational activities.
• Identify internal operational errors to prevent incorrect payments from being made.
• Identify and prevent fraudulent, wasteful, and abusive expenses.
• Identify suspicious activity and submit findings to designated internal teams for investigation.
• Work closely with other departments to ensure activities do not negatively impact customers.
• Provide feedback to other departments to put safeguards in place and prevent further risk exposure.
• Develop audit guidelines to meet compliance requirements.
• Develop and distribute audit reports on a regular basis and share findings with operations staff.
• Assist with third-party audits by completing questionnaires, validating selected claims, and responding to errors.

Skills & Qualifications

• More than 2 years of experience in medical administration, claims, or a customer service-focused organization.
• International claims processing experience preferred; insurance background preferable.
• Proficiency with Microsoft Excel required; Word, PowerPoint, Outlook, and SharePoint preferred.
• Strong interpersonal skills with good verbal and written communication to internal and external clients.
• Strong customer focus with ability to identify and solve problems.
• Ability to work on own initiative and proactively recommend process improvements.
• Ability to organize, prioritize, manage workflow, exercise judgment, and meet individual and team requirements; comfort with telephonic outreaches to global entities preferred.

Embedded within the freight audit function, the Audit Analyst delivers accurate verification, processing, and auditing of freight invoices while analyzing carrier cost and pricing to support negotiations. Working closely with Freight Payment Companies and internal stakeholders, the Audit Analyst advances rate analysis and carrier contract compliance to mitigate financial risk across the organization.

Core Functions

• Process freight invoices and monitor divisional billing and carrier payments.
• Conduct pre and post audits of billing.
• Analyze rate projects for internal customers including carrier annual or bi-annual rate increase analysis and negotiations.
• Monitor Freight Payment Companies audit functions and work directly with their audit group to ensure accurate and timely processing of carrier invoicing.
• Review carrier contracts and documents; validate carrier legal status to move medical supplies, license and insurance, etc.
• Conduct freight analysis of current and new business and analyze processing costs for carrier selection and rate increase negotiations.
• Maintain Rate Analysis Tools and assist in negotiations as required.

Qualifications & Experience

• At least 2 years of relevant audit experience.
• Parcel Audit experience is a plus.
• Parcel audit software implementation experience (worked on or implemented) preferred.
• Knowledge of the Transportation Industry including contract creation, carrier tariffs, rating knowledge, and automated TMS functionality.
• Intermediate proficiency in Microsoft Excel, PowerPoint, and Word.

A key member of the Quality Audit team, the Middle Revenue Cycle Quality Audit Analyst leads timely and accurate quality audit reviews of medical records to verify charge documentation, identify billing inaccuracies, and assess clinical department adherence to charge reconciliation. Collaborating across Training, Analytics, Vendor Management, and Revenue Cycle SMEs, this analyst delivers root cause analyses and actionable recommendations that drive continuous improvement and compliance with AdventHealth Corporate standards.

Functions

• Complete timely and accurate quality audit reviews while adhering to revenue cycle policies, procedures, and audit schedules; provide practical recommendations for standardizing audit policies and procedures.
• Communicate outcomes of quality audit reviews to Middle Revenue Cycle leadership and clinical departments via email, presentations, and other methods.
• Review dashboards with the Quality Audit, Training, and Education Supervisor to discuss key findings that drive continuous education.
• Conduct root cause analyses based on dashboard and account reviews to determine key issues and translate results into actionable recommendations; relay findings and action plans to the Quality Audit Supervisor.
• Collaborate with the Analytics team to determine QA metrics, dashboards, programming requests, and process changes to improve staff accuracy and efficiencies.
• Collaborate with the Vendor Management team to share business requirements, improve performance and process adherence, and track quality data.
• Collaborate with Trainers, Educators, and Middle Cycle leadership to assess improvement areas, determine training needs, develop quality/training tools, and share leading practice workflows across departments and regions.
• Support Trainers and Educators in meeting with new Middle Cycle hires within their first 90 days to ensure audits are comprehensive and meet service level agreements.

Minimum Qualifications

• Associate's Degree in Business, Accounting, Finance, Health Administration, or related field; or 2 years of relevant experience.
• Lean and Six Sigma Certification; Quality Assurance Certification preferred.
• 1 year of experience in healthcare or a related field with emphasis on billing, charging, or coding.
• 4 years of revenue cycle experience preferred.
• Knowledge of Medicare, Medicaid, and other third-party payer billing and reimbursement regulations preferred.
• Knowledge of Epic and associated Revenue Cycle applications preferred.

Internal Audit Analyst leads IT audit walkthroughs, SOX-404 ITGC testing across UHG Corporate, Optum, and UHC segments, and builds the ITGC framework for India legal entities while preparing complete work papers that meet department quality standards. The work directly supports the organization's control environment by tracking remediation plans through closure and maintaining relationships with external audit firms EY and DT.

Accountabilities

• Assist in the preparation of audit planning documentation for all assigned audits.
• Lead IT Audit Walkthroughs independently and perform Test of Design and Test of Operating Effectiveness for IT-GCC Controls.
• Perform detailed audit procedures and testing across application environments including Mainframe and Distributed; conduct Physical and Datacenter Audits.
• Perform SOX-404 ITGC testing for UHG Corporate, Optum, and UHC segments; build, implement, and test ITGC framework for India legal entities.
• Prepare clear, accurate, and complete work papers in accordance with department quality standards; meet project timelines and deliverable due dates.
• Build relationships with external audit firms (EY & DT); develop knowledge of control assessment frameworks and the overall control environment.
• Follow up on and track remediation plans for testing through closure; support Business Audit and ICFR testing projects during downtime.
• Comply with the terms and conditions of the employment contract, company policies, procedures, and all applicable directives.

Education & Experience

• Master's or Bachelor's in Science/Technology, Computer Science, Information Security, or related field.
• CISA, CRISC, ISO, or related audit/risk management certification preferred.
• Minimum 4 years of IT Audit, GCC Testing, SOX-404, or related experience.
• Hands-on experience conducting IT audits on Mainframe, distributed systems, operating systems, mobile computing, cloud, and big data; experience with e-GRC applications.
• Sound knowledge of IT processes and associated IT risk and controls including SDLC, backup/restore, job scheduling, logical security, and application architecture; knowledge of COSO and COBIT frameworks preferred.
• Proficiency in MS Excel, PowerPoint, and MS Visio; ability to work on large technology data sets.
• Strong interpersonal, verbal, and written communication skills including experience preparing dashboards, audit documentation, and summary reports; strong analytical and project management skills.
• Exposure to managing international clients; ability to influence and communicate across management levels and manage multiple tasks.

Embedded within the Ethics and Compliance Department, the Compliance Audit Analyst oversees OU Health policies and procedures, administers PolicyTech, and develops quarterly compliance communications for system-wide distribution. Working closely with OUH Legal, Risk Management, and department leaders, the Compliance Audit Analyst enables consistent policy adherence and high-risk area identification that protects organizational integrity across the health system.

Role Responsibilities

• Maintain oversight of OU Health policies and procedures; serve as administrator in PolicyTech for policies and procedures.
• Develop quarterly policy communications and education for system-wide distribution.
• Assist in distribution of patient rights, notices of privacy practices, EMTALA signage, and other compliance documents.
• Identify and report high-risk policy compliance areas to the Director, including policies past due for review or new policy owners needed due to staffing changes.
• Act as point of contact for policy-related questions; assist OUH Legal/Risk Management with policy requests and leaders with uploading departmental policies into PolicyTech.
• Serve on the OUH policy and procedure committee managing minutes and scheduling; serve as proxy author for Ethics and Compliance Policies and as Ethics & Compliance Department DESO.
• Perform other duties as assigned and maintain confidentiality.

Background & Experience

• Bachelor's Degree required; degree in healthcare preferred; or equivalent combination of education and experience.
• 2 or more years of professional work experience required; compliance and policy experience in a healthcare setting preferred.
• Knowledge of compliance management.
• Strong computer skills including Microsoft Word, Excel, and PowerPoint.
• Ability to perform effective research, prepare document summaries, and manage contracts.
• Detail-oriented with excellent organizational skills; good verbal and written communication skills.
• Ability to work independently and as part of a team, coordinate a varying workload, adapt to changing priorities, and apply knowledge to make quick and accurate decisions.

As the Global Audit Analyst, this role prepares, coordinates, and manages the client's global audit schedule, overseeing audit scheduling, document review, supplier communication, and review of submitted audit results to ensure alignment with client requirements. The Global Audit Program relies on this work to maintain quality control standards and deliver accurate operational reporting to both client and supplier Senior Management.

Scope of Work

• Support the daily operations of the Global Audit Program.
• Coordinate audit preparation and scheduling; liaise and collaborate closely with the Audit Program team.
• Ensure overall quality control and conduct reviews of submitted audits for accuracy and high standards.
• Assist with conducting virtual audits as required.
• Complete monthly and weekly operational reports per client requirements; prepare reports and dashboards.
• Maintain confidentiality regarding company and site information and technology systems.
• Adhere to all company and site IT policy and procedure guidelines.
• Undertake other reasonable and lawful duties pertaining to the role as directed by the client.

Experience & Qualifications

• 3–5 years of experience in security, auditing, or compliance.
• Experience in Business Continuity Disaster Recovery assessments using ISO standards.
• Proficiency in Google applications (Drive, Docs, Sheets, Gmail) and other software platforms; intermediate to advanced data management skills.
• Strong interpersonal, leadership, and communication skills (written and oral).
• Highly organized with ability to multitask, prioritize, and work to deadlines.
• Highly motivated, team-oriented, flexible, adaptable, detail-oriented, and proactive in seeking process and technology improvements; professional and acts with integrity at all times.

Senior Internal Audit Analyst builds and executes internal audit activity across designated specialty areas, supporting financial, business process, and information systems audits including Sarbanes-Oxley testing to assess the existence, effectiveness, and efficiency of business controls. Success in the position means clear and accurate workpapers are delivered on time, audit issues are identified with root cause solutions, and action plan follow-up is completed to keep business partners accountable.

Strategic Responsibilities

• Assist audit management or audit lead in executing internal audits including planning, detailing control procedures, and related testing and reporting in accordance with professional and departmental standards, including Sarbanes-Oxley testing.
• Prepare clear, accurate, and complete workpapers in accordance with department quality standards; meet project timelines and deliverable due dates.
• Identify audit issues and perform root cause analysis with practical corrective solutions.
• Perform follow-up on assigned audit report action plans to ensure business partners have completed agreed-upon actions.
• Participate in special projects undertaken by the department and/or the Company.

Education & Experience

• Bachelor's degree in Accounting, Finance, Technology, or related discipline.
• 2+ years of accounting or auditing experience preferred; Sarbanes-Oxley, MAR, or SOC experience preferred.
• 1+ year of relevant business experience.
• Understanding of internal control concepts and their practical application.
• Solid interpersonal, analytical, oral, and written communication skills.
• Ability to work effectively within a team.

The Audit Analyst delivers execution of financial audits in partnership with External Auditors across HCB, PBM, LTC, Retail, and Corporate segments, producing accurate workpapers and coordinating projects with Internal Audit management, business line partners, and external audit firms. Working under the supervision of more experienced auditors, the Audit Analyst shapes process enhancement opportunities through data analytics tools and maintains effective communication throughout the project lifecycle, with approximately 10% domestic travel required.

Day-to-Day Responsibilities

• Interact with Internal Audit, business line management, and external auditors to coordinate projects and resolve issues in a timely manner while maintaining effective communications before and after project completion.
• Produce accurate, complete, and well-organized workpapers for Internal Audit management review.
• Effectively perform and document audit activities in accordance with professional standards and CVS Health's audit methodology.
• Organize and prioritize multiple tasks within established budgets and agreed-upon timelines.
• Identify opportunities to enhance processes by utilizing data analytics tools.
• Encourage teamwork and a positive environment to improve team effectiveness.

Professional Experience

• CPA, CIA, or MBA certification preferred.
• Public Accounting or publicly traded auditing/accounting experience.
• Practical knowledge of processes, risk, and internal controls.
• Proficiency in Microsoft Office.
• Strong analytical, organizational, and time management skills.
• High attention to detail.
• Good oral and written communication skills.

The Audit Analyst guides analysis of freight contracts, financial transaction data, and logistics cost components to uncover opportunities and mitigate financial risks within a Cebu-based data analytics function. Working closely with internal and carrier stakeholders, the Audit Analyst delivers weekly, monthly, and quarterly reports that enable data-driven decision-making across the supply chain.

Key Deliverables

• Analyze freight contracts across modes, equipment types, and carriers to uncover areas of opportunity and mitigate financial risks.
• Identify solutions and execute to drive results.
• Prepare weekly, monthly, and quarterly reports.
• Provide analysis and interpretation of information regarding logistics cost components.
• Gather data, analyze results, and determine the best solution to solve problems; apply results to solve similar problems.
• Analyze financial transaction data to find patterns, trends, and inconsistencies.

Knowledge Skills & Abilities

• Bachelor's degree in Engineering, Business, Logistics, Supply Chain, or a related field; 1–5 years of work experience.
• Relevant work experience in a Shipping or Carrier Company preferred; data analytics, finance, or statistics background preferred.
• Advanced proficiency in Microsoft Office (Word, Excel) essential; SQL/Access and Finance/Accounting knowledge an advantage.
• Excellent problem-solving and analytical skills; excellent written and oral communication skills.
• Strong time management, prioritization, and organizational skills; highly detail-oriented and customer service driven; ability to function in a fast-paced, dynamic environment.