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in Boston, MA

Hours Full-time, Part-time
Location Boston, Massachusetts

About this job

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM

The Field Based-Compliance Auditor will work with our network of contracted providers to ensure compliance and adherence to all regulatory requirements per the contract. This will include and not limited to the annual Frail Elder Waiver Attestation Audit, as the Field Based Compliance Auditor will oversee the process, collection, and onsite audit requirements of all required contracted Home Community Based Service (HCBS) provider types.

Positions in this function are responsible for investigating, recovering and resolving all types of regulatory requirements for Massachusetts UnitedHealthcare’s Community and State Plan.  May include initiating telephonic calls, email communication and on-site audits with our network of contracted providers to gather required documentation to satisfy regulatory and compliance requests.  Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. 

Primary Responsibilities

  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.

  • Outward provider facing role with contracted providers to investigate and recover required documentation to resolve all types of compliance related activities/audits

  • Initiate deficiency process and lead remediation efforts with providers who fail to comply

  • Lead and develop process improvements to ensure provider compliance

  • Ensure adherence to state and federal compliance policies and contract compliance 

  • Ability to travel onsite to providers within the state of Massachusetts to conduct audits

  • Ensure audit projects meet established objectives for timeliness and productivity

  • Track audit status and detail audit project plans

  • Use analytical thought process to dissect complex issue, and complete appropriate steps to resolve identified issues

  • Manage ambiguity, work autonomously, and multi-task in a matrix environment

  • Follows standard audit protocols and procedures for all projects

  • Use pertinent data and facts to identify and solve a range of problems within area of expertise

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High school diploma / GED (or higher) OR equivalent experience

  • Intermediate proficiency within Microsoft Office Suite specifically with Excel

  • Managed Care experience

  • Ability to work 8am-5pm. It may be necessary, given the business need, to work occasional overtime or weekends. 

  • Ability to travel 50% of the time

Preferred Qualifications:

  • Bachelors Degree (or higher)

  • 2+ year healthcare and/or audit experience

  • 2+ year experience in healthcare, managed care, compliance, or audit

  • 1+ year experience with Medicare and Medicaid regulations

Soft Skill:

  • Strong planning and organizational skills

  • Proven organization, planning, prioritizing and multi-tasking skills

  • Ability to work independently, in a team, and cross functionally

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV / AIDS and High - risk Pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life’s best work.SM

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.