Senior Clinical Compliance Auditor

This is a fully remote position, open to applicants in Brazil, +5 more states.

📋 Description

• Develop and implement a continuous internal audit program, which includes pre-bill and post-bill chart evaluations, monthly sampling, and focused audits initiated by risk indicators.

• Evaluate ABA clinical documentation against payer and state Medicaid standards, encompassing session notes, treatment plans, reassessments, prior authorizations, supervision regulations, provider accuracy, and time/unit documentation.

• Compute and analyze error rates at both center and provider levels, determine root causes, and highlight documentation deficiencies before they are identified by payers.

• Keep an updated four-state requirements matrix for Iowa, Illinois, Nebraska, and South Dakota, ensuring it reflects any changes in regulations and payer guidelines.

• Oversee the configuration and daily operations of the Brellium audit platform, which includes reviewing AI flags, managing rule sets, and generating reports.

• Create audit dashboards and key performance indicators (KPIs) for leadership and operational teams.

• Observe changes in coding and payer policies, including upcoming CPT updates, and adapt them into revised templates, workflows, training materials, and audit protocols.

• Maintain a consolidated audit log and assist in external audit defense by compiling records-request packets, drafting rebuttal and appeal documents, and monitoring deadlines and financial implications.

• Write corrective action plans, training resources, job aids, and documentation samples to assist clinical teams and promote measurable improvements.

• Collaborate closely with the Revenue Cycle, Compliance, DCOs, BCBAs, center leadership, and IT in a primarily asynchronous work setting.

⛳️ Requirements

• 3–5+ years of experience in U.S. healthcare compliance, clinical auditing, or medical coding/documentation review.

• Experience in supporting Medicaid and/or MCO audit responses, including preparation of records, drafting rebuttals, or providing appeals support.

• Comprehensive understanding of U.S. Medicaid documentation and medical necessity standards.

• Exceptional written English skills, with the capability to produce payer-ready summaries and leadership reports requiring minimal editing.

• Proven ability to track changes in CPT, coding guidelines, and payer policies, translating them into operational updates.

• Proficient with EHR or practice management systems and data tools for sampling, error rate monitoring, and reporting.

• Strong integrity, discretion, and adherence to HIPAA regulations when managing PHI.

• Capability to work remotely while maintaining at least 4 hours of overlap with U.S. Central Time.

🏝️ Benefits

• Compensation provided in USD.

• Fully remote work environment.

• Opportunities for growth within a high-expansion international company.