Senior Compliance Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist the compliance department by reviewing legal documentation.

• Conduct and respond to audits, both internal and external, across all jurisdictions.

• Aid in conflict reporting and work alongside the finance department to resolve issues.

• Subpoena medical records and manage general record requests.

• Investigate claims related to fraud, waste, and abuse.

• Provide recommendations for next steps regarding FWA claims.

• Act as a resource for escalated issues across all active states.

• Execute quality assurance reviews.

• Carry out additional compliance responsibilities as assigned.

• Ensure adherence to regulatory requirements.

⛳️ Requirements

• Bachelor’s degree with at least 3 years of experience in the healthcare sector, or an associate degree with a minimum of 5 years of experience in the healthcare sector.

• In-depth understanding of Medicaid regulations.

• Experience in exclusion screening and conducting background checks.

• Previous experience with both internal and external audits.

• Extensive knowledge of billing and coding preferred.

• Ability to apply sound judgment in accordance with best practices, regulations, and business processes.

• Capacity to work independently on complex issues.

• Self-motivated individual who takes initiative.

• Detail-oriented and meticulous.

• Dependable and attentive to details.

• Skilled in managing multiple tasks simultaneously.

🏝️ Benefits

• Medical benefits.

• Retirement plans.

• Wellness programs.

• Fun company events.

• Ongoing learning opportunities.

• Competitive compensation.

• Inclusive work environment.

• Equal Opportunity Employer.