Director Medicare Rac Audit Jobs (NOW HIRING)

Job Profile Summary

The VP, Internal Audit is a highly visible senior leadership role responsible for directing the internal audit functionat Alignment Healthcare, Inc., with accountability for SOX compliance, enterprise risk management, and regulatory oversight across all business operations. This leader works in close partnership with the Audit Committee, CFO,CAO,executive leadership, legal, compliance, finance, and business unit leaders to strengthen the overall control environment and position internal audit as a trusted advisor-not merely a compliance function. Drawing on deepexpertisein Medicare Advantage risk adjustment, RADV compliance, and encounter data integrity, this role drives continuous improvement of internal controls, proactively surfaces emerging risks, and ensures the organizationoperateswith the highest standards of accountability. This is a critical enterprise function whose outcomes directly protect patients,maintainregulatory standing, and support the organization's mission of delivering high-quality, cost-effective care to MedicareAdvantage-enrolled seniors.

Job Duties / Responsibilities

SOX Program Leadership & Internal Control Governance

• Lead the design, execution, and continuous improvement of the company's SOX 404 program, including scoping, risk assessment, control design, testing, and documentation.

• Drive governance over the outsourcedinternalaudit partner, holding them accountable for quality, timelines, and professional standards.

• Ensureall SOX documentation and testing results are complete,accurate, and maintainedin accordance withPCAOB standards and internal policy.

Enterprise Risk Assessment("ERM")& Audit Planning

• Overseesthe Company's ERM processbydevelopingandexecutinga risk-based annual audit plan that provides comprehensive coverage of financial, operational, IT, and regulatory risks across the organization.

• Proactivelyidentifycontrolenvironment gaps and emerging risks before theyescalate, andcommunicate findings with timeliness and transparency to senior management and the Audit Committeewhen needed.

Medicare Advantage Regulatory Compliance Oversight

• Assess compliance requirements specific to the Medicare Advantage regulatory landscape, including the Model Audit Rule, RADV readiness,andencounter data integrity.

• Partner with compliance, legal, and actuarial leaders to ensure audit programs reflect current CMS regulations.

Control Deficiency Remediation & Management Accountability

• Oversee the identification of root causes behind control failures,monitorremediation efforts, and hold management accountable fortimelyand durable resolution of deficiencies.

• Deliver regular, clear status updates to executive leadership and the Audit Committee-translating complex audit findings into actionable business intelligence.

Operational Audit Leadership

• Lead operational audits across all functional areas-finance, HR, claims, medical management, pharmacy, andtechnology-applyinga consistent, risk-basedmethodologyto evaluate process integrity andidentifyefficiency opportunities.

• This includes overseeing IT general controls (ITGCs) and system-level controls related to ERP, claims, and data migration initiatives.

Control Culture & Business Partnership

• Embed a culture of accountability by serving as a trusted advisor to business leaders on effective control design, helping them understand what "good" looks like in practice.

• Move the organization from a compliance-driven mindset toone ofownership, where controls are embedded in daily operations rather than layered as an after-thought.

Audit Committee Engagement & Executive Reporting

• Serve as the primary liaison to the Audit Committee Chair, providing regular reporting on audit results, risk exposure, program quality, and remediation progress.

• Apply strong executive presence and communication skills to translate audit data into strategic insights for the Board and senior leadership.

Supervisory Responsibilities

This role carries supervisory responsibility over theCompany's third-party external audit team, including oversight of quality, work standards, timelines, reporting, and cost management.

Supervisory Requirements: Fulfill supervisory responsibilities in accordance with organization policies and applicable laws.Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Job Requirements

Experience

Required:

• 15+ years of progressive internal audit, external audit, or financial controls experience, with at least 5 years in a senior leadership role

• 8+ years of experience with a publicly traded company, including demonstrated knowledge of SEC reporting requirements and PCAOB auditing standards

• Deepexpertisein Medicare Advantage plans, risk adjustment, and healthcare operations, including familiarity with CMS regulations, RADV, and the Model Audit Rule

• Experience leading audit work in complex, regulatedhealthcareor insurance environments with strong emphasis on SOX and COSO framework application

• Demonstrated experience directing and governing outsourced or co-sourced audit partnerships, including vendor management and quality oversight

Preferred:

• Experience supporting Audit Committee reporting and direct interaction with Board-level governance bodies

• Prior experience at a Big 4 public accounting firm or national advisory firm within a healthcare or managed care practice

• Exposure to ERP implementation controls, data migration audits, and IT general controls in a healthcare setting

Education

Required:

• Bachelor's degree in Accounting, Finance, Business Administration, or a closely related field

Preferred:

• Master's degree in Accounting, Business Administration (MBA), or Healthcare Administration

• Graduate coursework or certification in risk management, internal auditing, or healthcare compliance

Training

Required:

• Ongoing professional development in internal auditing standards, including IIA (Institute of Internal Auditors) standards and the COSO Internal Control Integrated Framework

• Demonstrated working knowledge of PCAOB standards, SEC reporting requirements, and SOX Section 404 implementation

Preferred:

• Training in Medicare Advantageregulatory compliance, including CMS audit readiness, RADV methodologies, and encounter data management

• Coursework or training in enterprise risk management frameworks (e.g., COSO ERM, ISO 31000)

• Data analytics and audit technology training (e.g., ACL/Galvanize,TeamMate, or similar audit management tools)

Skills & Competencies

Technical / Role-Specific Skills

• SOX 404 Program Management (Advanced):Demonstratedmastery of scoping, risk assessment, control design, testingmethodology, and PCAOB-compliant documentation across financial and IT controls

• Medicare Advantage & Healthcare Regulatory Compliance (Advanced): In-depth knowledge of CMS regulations, risk adjustmentmethodology, RADV audit processes, encounter data integrity, and the Model Audit Rule as they apply to Medicare Advantage health plans

• Enterprise Risk Management (Advanced): Ability to design and execute risk-based audit plans that address financial, operational, IT, and regulatory risks across complex, multi-functional organizations; fluency with COSO ERM framework

• IT General Controls & Systems Audit (Intermediate to Advanced): Working knowledge of IT general controls, ERP control environments, data migration oversight, and systems implementation auditing-particularly in claims, pharmacy, and financial systems

• Audit Committee & Executive Communication (Advanced): Exceptional written and verbal communication skills; ability to translate complex audit findings into concise, strategic narratives for Board-level and C-suite audiences whilemaintainingfull independence from management decision-making

• Remediation Management & Root Cause Analysis (Advanced): Systematic approach toidentifyingroot causes of control breakdowns, designing corrective action plans, and driving sustainable resolution with measurable outcomes

• Data-Driven Audit Analytics (Intermediate): Familiarity with audit analytics tools (e.g., ACL, IDEA, Tableau, or similar) to enhance audit coverage,identifyanomalies, and improve audit efficiency across large data sets common in healthcare and claims environments.

Licensure

Required:

• No specific licensure is mandated; however, active professional standing in a recognized auditing or accounting credential is strongly expected at this level

Preferred:

• Certified Public Accountant (CPA) - strongly preferred;indicatestechnical grounding in financial reporting, accounting standards, and attestation

• Certified Internal Auditor (CIA) -preferred; the global standard for internal audit professionals,demonstratingproficiencyin IIA Standards, risk management, and governance

• Certified Information Systems Auditor (CISA) -preferred, particularly given the IT controls and ERP oversight responsibilities of this role

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.Reasonableaccommodationsmay be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employeeis regularly required totalk or hear. The employee regularlyis required tostand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

• The employeefrequentlylifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwiseparticipatingin the employee selection process, please contactcareers@ahcusa.com.