Lead Auditor - IDR Entity Audit (CMS)

Responsibilities

• Ensure audits are performed in a consistent, impartial, and objective manner across all certified IDR entities.
• Supervise project audit teams, including assignment of work, mentoring, and review of junior auditors' output.
• Manage and execute completion of assigned tasks within established timelines for standard and expedited audits.
• Provide quality control over audit workpapers, evidence, findings, and recommendations to ensure each audit is well-documented and defensible.
• Review the project team's audit work, including documentation supporting eligibility and payment determination findings, and the rationale documented in draft audit reports.
• Provide technical assistance to CMS and project staff on audit methodology, including statistically representative sampling design, treatment of single vs. batched disputes, handling of reopened determinations, and assessment of clerical, procedural, or jurisdictional errors.
• Review audit reports and other deliverables and interact with the client on program and technical issues, including the Audit Strategy, individual audit reports, and the Preliminary and Final Annual Audit Reports.
• Apply knowledge of Generally Accepted Accounting Principles (GAAP), Government Auditing Standards (GAS), and applicable Federal regulations - including guidelines, standards, and concepts - and other relevant industry practices to each engagement.
• Assess certified IDR entity compliance with eligibility determination requirements (including batching, State All-Payer Model Agreements, and specified State law applicability), payment determination procedures, recordkeeping, and reporting timeframes.
• Identify recurring issues, emerging trends, and "red flags" for escalation; support calculation of financial impact (e.g., collected but unremitted administrative fees) where applicable.
• Safeguard sensitive healthcare information and ensure audit execution complies with the No Surprises Act, 45 CFR 149.510, and all contract security and privacy requirements.
• Required Qualifications
• Minimum of seve

Benefits

Additional Information

At Broadway Ventures , we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. About the Project We are building a team to deliver the Independent Dispute Resolution (IDR) Entity Audit for the Centers for Medicare & Medicaid Services (CMS), in support of the Departments of Health and Human Services, Labor, and the Treasury (the Tri-Departments). This contract is being competed under solicitation RFQ 75FCMC26Q0070. Enacted as part of the Consolidated Appropriations Act of 2021, the No Surprises Act (NSA) protects patients from unexpected out-of-network medical bills. When an insurer and an out-of-network provider cannot agree on a payment amount, the Federal IDR Process allows a certified IDR entity to determine the appropriate payment. Our team will independently audit those certified IDR entities to verify that their eligibility and payment determinations are compliant with the NSA and its implementing regulations - directly supporting decisions about certification, recertification, and revocation. This is a multi-year, time-and-materials engagement structured in two phases: Phase 1 - Initial Operations (Baseline Establishment), followed by an optional transition to Phase 2 - Scaled Operations. The anticipated period of performance begins August 28, 2026 and extends through August 27, 2031 (base + four option periods), with an optional transition-out period. Position Summary The Lead Auditor is designated as Key Personnel and is responsible for managing and directing audits of certified IDR entities to meet timeliness and quality standards. The Lead Auditor leads the design and execution of Eligibility Determination Audits and Payment Determination Audits, supervises project audit teams, and serves as the technical authority for audit methodology, sampling, workpapers, findings, and recommendations. Location & Work Arrangement This is a fully remote position. The place of performance is at the contractor's site, not at a CMS facility, so the selected candidate may work from any location within the Continental United States (CONUS data residency is a contract requirement). Occasional travel to CMS offices in Baltimore, MD may be required for milestone reviews or stakeholder meetings. This role is ideal for a credentialed audit professional with deep healthcare program-integrity expertise who can deliver disciplined, defensible audits that support CMS's certification, recertification, and revocation decisions for certified IDR entities.

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