Healthcare Compliance Auditor

Job Summary

Conducting detailed reviews of healthcare claims and billing practices, the full-time remote Compliance Auditor will ensure adherence to regulatory requirements, analyze large data sets for patterns of waste or fraud, and prepare comprehensive audit reports with corrective action recommendations.

Key responsibilities

• Plan and perform audits using statistically valid sampling to verify charges and assess medical necessity
• Document findings clearly and prepare preliminary and final audit reports, including overpayment calculations
• Collaborate with internal teams and clients to support provider education on compliance best practices and contribute to audit process improvements

Required qualifications

• Strong auditing and quality auditing skills with experience in healthcare or compliance audits
• Demonstrated knowledge of healthcare regulations, billing, coding, and HIPAA requirements
• Advanced analytical skills for interpreting large data sets and identifying trends
• Relevant certification such as CPC, CPMA, or CHC is preferred
• Bachelor's degree in Healthcare Administration, Finance, Business, or related field, or equivalent professional experience