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Compliance and Audit Specialist

3 weeks, 4 days ago
United States
Full-time
Mid Level
Compliance Manager
Finance and Accounting
HIPAA
Apply Now
Curai Health

Curai Health

Curai Health is a text-based primary care service that combines human intuition with advanced AI to provide a fast and hassle-free healthcare experience. They aim to make quality healthcare accessible to all by improving cost-effectiveness and scalabil...

Health Care Providers & Services
51-250
Founded 2017
$38M raised
View All Jobs 3

Description

  • Monitor and interpret changes in healthcare laws, regulations, and agency guidance (e.g., CMS, OIG, OCR) and assess impacts on virtual care operations.
  • Conduct periodic risk assessments to identify compliance vulnerabilities and recommend corrective actions.
  • Plan and conduct internal compliance audits of clinical documentation, billing and coding practices, referral arrangements, and operational workflows in outpatient and clinic settings.
  • Develop audit tools, work plans, and sampling methodologies appropriate to ambulatory care environments.
  • Analyze audit findings, prepare detailed reports with root-cause analyses, and track corrective action plans through resolution.
  • Receive, triage, and investigate compliance concerns and hotline reports; document investigation findings and maintain investigation files.
  • Assist with voluntary self-disclosures, refund processes for overpayments, and other remediation activities.
  • Draft, review, and update compliance policies, procedures, and standard operating procedures; assist with annual work plan and compliance committee materials.
  • Develop and deliver compliance training and targeted education for outpatient/clinic staff; serve as day-to-day compliance resource for managers, providers, and staff.
  • Partner with revenue cycle, health information management, clinical operations, HR, and external regulatory bodies; prepare materials for compliance committee meetings and leadership reporting.

Requirements

  • Bachelor's degree in Healthcare Administration, Health Information Management, Nursing, Business Administration, Public Health, or related field (or equivalent education and experience).
  • Minimum of 3–5 years of progressive experience in healthcare compliance, regulatory affairs, coding/billing auditing, or a closely related function.
  • Demonstrated experience conducting compliance audits and investigations in a healthcare environment.
  • Working knowledge of Medicare and Medicaid billing regulations, CPT/ICD-10 coding, and payer requirements applicable to outpatient services.
  • Must hold (or obtain within 12 months of hire) one or more certifications: CHC (HCCA), CHPC (HCCA), or CPCO (AAPC); CCS or CPC coding credentials are a plus.
  • Strong understanding of federal and state fraud and abuse laws (Anti-Kickback Statute, Stark Law, False Claims Act), HIPAA/privacy, EMTALA, and CMS Conditions of Participation/Coverage.
  • Excellent analytical, critical-thinking, written, and verbal communication skills with the ability to translate regulations into actionable guidance.
  • High degree of integrity, professionalism, discretion, and ability to manage multiple projects with minimal supervision.
  • Proficiency in Microsoft Office; experience with compliance management software or data analytics tools is a plus.
  • Preferred: Master's degree, experience with multi-site clinic or health system compliance operations, familiarity with EHR systems (Epic, Athenahealth, eClinicalWorks), and experience with OIG guidance for small physician practices.

Benefits

  • Base salary range $90,000–$120,000 (actual offer depends on qualifications and experience).
  • Comprehensive medical, dental, and vision coverage.
  • 401(k) employer match.
  • Annual CME reimbursement.
  • Remote role with standard business hours and occasional flexibility to address urgent compliance matters.
  • Competitive benefits package.

Interested in this position?

Apply directly on the company website

Apply Now

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