Contract Compliance Auditor

Bronson Healthcare

21h•Hybrid

About The Position

The Contract Compliance Auditor is responsible for proactively monitoring, auditing, and creating processes to enforce compliance with managed care payor contract terms on behalf of the Managed Care Department. This position is accountable for identifying payor underpayment, inappropriate denials, incorrect application of contract terms, audit overreach, and other forms of noncompliance through systematic review of claims, remittances, audit activity, and payor behavior patterns. The Contract Compliance Auditor serves as a subject matter expert in contract interpretation and application, translating complex contract provisions into actionable findings that protect Bronson’s financial and contractual interests. This position works collaboratively within a matrixed Payor Defense Team, partnering closely with Business Analytics, Revenue Cycle, Finance, Clinical, and Managed Care stakeholders to validate findings, identify analytical needs, and coordinate resolution strategies. While not expected to independently develop complex analytical models, the Contract Compliance Auditor is responsible for identifying where deeper analysis is required, defining the business and contractual questions to be answered, and working with analytical partners to drive appropriate modeling and reporting. The Contract Compliance Auditor will take initiative to identify root causes of payor noncompliance and recommend corrective actions, both internally and externally, to prevent recurrence. This role functions as an individual contributor with subject matter expert authority and will serve as a lead in audit response efforts, compliance reviews, and payor defense initiatives. The position operates with a high degree of independence and professional judgment. The Contract Compliance Auditor shall maintain deep subject matter expertise related to Bronson’s managed care payor contracts, reimbursement methodologies, audit rights, dispute resolution provisions, and incorporated regulatory references contained within contractual language. This position is accountable for developing repeatable audit processes, tools, and documentation standards that support continuous monitoring of payor compliance. The Contract Compliance Auditor will have the autonomy to educate internal stakeholders on contract enforcement risks, trends, and opportunities in support of revenue integrity and payor accountability. Position is a hybrid role with expectations of onsite work.

Requirements

Bachelor's Degree in a related field such as finance, accounting, healthcare administration, nursing, medical records, or business OR experience equivalent to this degree of at least 7 years in a related field.
Background in managed care contracting, reimbursement analysis, audit activity, or revenue cycle operations is strongly preferred.
Experience supporting or responding to third party payor audits is preferred.
Advanced analytical and problem-solving skills are required, including the ability to interpret complex contract language and apply it accurately to claims and reimbursement outcomes.
Strong understanding of managed care principles, healthcare reimbursement methodologies, billing requirements, and audit processes.
Demonstrates initiative to continually enhance understanding of payor behavior, contract enforcement strategies, and evolving reimbursement environments.
Ability to work independently, serve as a subject matter expert, and lead contract compliance efforts within a matrix team.
Proficient in the use of computer applications with advanced skills in MS Excel preferred.
Comfort working with large data sets, contract management systems, and remittance data is expected.
Work produces high levels of mental and visual fatigue requiring sustained concentration, detailed review, and analytical thinking for extended periods of time.
The role involves significant use of a personal computer and data analysis tools.
Excellent verbal and written communication skills are required, including the ability to clearly document findings, articulate compliance concerns, and support dispute and escalation activities.
Strong interpersonal skills and professionalism are essential, as this role interfaces regularly with internal stakeholders and external payor representatives.

Responsibilities

Monitors and audits payor reimbursement to ensure compliance with contractual terms and provisions.
Identifies underpayments, incorrect payment methodologies, inappropriate denials, audit overreach, and other forms of payor noncompliance.
Defines audit scope, methodology, and documentation standards in collaboration with internal partners.
Partners with Business Analytics and Revenue Cycle teams to identify analytical needs and support development of reimbursement models and reporting.
Supports payor audit response and dispute resolution efforts through defensible documentation and contract interpretation.
Evaluates payor audit findings for contractual and regulatory appropriateness as incorporated into contract language.
Identifies systemic issues and recurring payor behavior patterns requiring intervention.
Serves as a subject matter expert supporting escalations, negotiations, and contract interpretation.
Educates internal stakeholders on contract compliance risks, trends, and enforcement opportunities.
Maintains detailed documentation to support internal governance, payor discussions, and leadership review.
Performs other duties as assigned to support departmental operations, organizational priorities, and the needs of leadership