Senior Clinical Compliance Auditor
New
S
Stride Autism CentersHealthcare Compliance
São Paulo, State of São Paulo, Brazil. Mexico City, Mexico City, Mexico. Panama City, Panama, Panama. Santiago, Santiago Metropolitan Region, Chile. Buenos Aires, Buenos Aires, Argentina. Medellín, Medellin, Colombia, At least 4 hours of overlap with U.S. Central Time.Full-TimeSenior
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Languages
- Excellent written English
- Experience
- 3–5+ years
- Required Skills
- Data AnalysisEHRHIPAA
Requirements
- 3–5+ years of experience in U.S. healthcare compliance, clinical auditing, or medical coding.
- Experience supporting Medicaid and/or MCO audit responses, including records preparation or appeals support.
- Strong knowledge of U.S. Medicaid documentation and medical-necessity standards.
- Excellent written English with the ability to produce payer-ready summaries and reports.
- Demonstrated ability to track CPT, coding-guideline, and payer policy changes.
- Proficiency with EHR or practice-management systems and data tools for error-rate tracking.
- Ability to maintain HIPAA compliance and handle PHI with integrity and discretion.
- Ability to work remotely with at least 4 hours of overlap with U.S. Central Time.
- CPC, COC, CPMA, or CHC certification preferred.
- Experience in a U.S. healthcare RCM, coding, or audit services environment preferred.
- Experience with ABA compliance or auditing, specifically CPT 97151–97158 preferred.
- Experience with CentralReach and Brellium audit platforms preferred.
Responsibilities
- Design and execute a recurring internal audit program, including pre-bill and post-bill chart reviews, monthly sampling, and targeted audits.
- Audit ABA clinical documentation against payer and state Medicaid requirements.
- Calculate and trend provider-level error rates to identify documentation gaps.
- Maintain a four-state regulatory requirements matrix covering Iowa, Illinois, Nebraska, and South Dakota.
- Manage the configuration and day-to-day operation of the Brellium audit platform.
- Build audit dashboards and KPIs for leadership and operational teams.
- Monitor coding and payer policy changes and translate them into updated templates and workflows.
- Support external audit defense by assembling records-request packets and drafting appeals.
View Full Description & ApplyYou'll be redirected to the employer's site
