Third-Party Clinical and Claims Auditor

This subcontract opportunity is for a Third-Party Clinical and Claims Auditor to support prime contractors on Medicare Advantage plan projects for Fairfax County Public Schools. The selected provider will be responsible for conducting clinical audits to verify medical necessity and performing claims audits to ensure billing accuracy and strict adherence to plan design. To successfully execute these tasks, the contractor must maintain HIPAA compliance and have the capability to access healthcare claims data systems. The primary deliverables for this engagement include detailed audit reports that outline specific findings, calculated error rates, and recommendations for corrective actions. Interested parties should note that the response deadline for this opportunity is November 6, 2026. The project falls under NAICS code 541219 and is managed through the Fairfax County Public Schools procurement system.