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Senior Clinical Compliance Auditor

29 minutes ago
Mexico, Argentina, Brazil, Chile, Panama, Colombia
Full-time
Senior
Operations Specialist
Operations
HIPAA
Apply Now
Workana

Workana

Workana: Leading Latam's freelance marketplace, connecting top talent with innovative projects for remote and freelance work.

Internet Software & Services
1K-5K
Founded 2012
$3M raised
View All Jobs 90

Description

  • Design and execute a recurring internal audit program with chart reviews, monthly sampling, and risk-based targeted audits.
  • Audit ABA clinical documentation against payer and state Medicaid requirements.
  • Track center-level and provider-level error rates, identify root causes, and surface documentation gaps.
  • Maintain a four-state requirements matrix for Iowa, Illinois, Nebraska, and South Dakota.
  • Own configuration and daily operation of the Brellium audit platform, including AI-flag review, rule-set management, and reporting.
  • Build audit dashboards and KPIs for leadership and operational teams.
  • Monitor coding and payer policy changes and translate them into updated templates, workflows, training, and audit rules.
  • Support external audit defense by assembling records packets, drafting rebuttals and appeals, and tracking deadlines and exposure.
  • Draft corrective action plans, training materials, job aids, and documentation examples.
  • Partner with Revenue Cycle, Compliance, DCOs, BCBAs, center leadership, and IT in a mostly asynchronous environment.

Requirements

  • 3–5+ years of experience in U.S. healthcare compliance, clinical auditing, or medical coding/documentation review.
  • Experience supporting Medicaid and/or MCO audit responses, including records preparation, rebuttal drafting, or appeals support.
  • Strong knowledge of U.S. Medicaid documentation and medical-necessity standards.
  • Excellent written English and the ability to produce payer-ready summaries and leadership reports with minimal editing.
  • Demonstrated ability to track CPT, coding-guideline, and payer policy changes and turn them into operational updates.
  • Proficiency with EHR or practice-management systems and data tools for sampling, error-rate tracking, and reporting.
  • Strong integrity, discretion, and HIPAA compliance when handling PHI.
  • Ability to work remotely with at least 4 hours of overlap with U.S. Central Time.
  • CPC, COC, CPMA, or CHC certification (nice to have).
  • Experience in a U.S. healthcare RCM, coding, or audit services environment (nice to have).
  • ABA compliance or auditing experience, especially with CPT 97151–97158 (nice to have).
  • Experience with multi-state Medicaid and major MCOs, including Centene/Iowa Total Care and Molina (nice to have).
  • Experience with CentralReach and automated chart-auditing platforms such as Brellium (nice to have).

Benefits

  • Compensation in USD.
  • Fully remote work.
  • High-growth opportunities in an international company.

Interested in this position?

Apply directly on the company website

Apply Now

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