[Remote] Corporate Compliance Clinical Auditor
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization committed to providing excellent care through its dedicated team. They are seeking a Corporate Compliance Clinical Auditor to conduct audits of post-acute care facilities, ensuring adherence to compliance standards and supporting the implementation of best practices.
Responsibilities
- Conduct retrospective, reputed company, and prospective audits of medical records across skilled nursing, home health, and hospice settings to assess compliance with billing, coding, documentation, and reputed company standards
- Identify discrepancies, errors, or potential non-compliance with federal/state regulations, payer requirements, and internal policies
- reputed company and manage internal compliance audits, ensuring reputed company completion, accurate documentation, and development of corrective reputed company plans
- reputed company audit reputed company and collaborate with stakeholders to implement monitoring strategies that support sustained compliance
- Support reputed company- and post-payment audit responses by coordinating documentation, tracking deadlines, and communicating with payers as directed
- Collaborate with clinical, billing, and operational teams to reputed company required documentation
- Assist in managing denial responses, including gathering supporting documentation and contributing to appeal strategies
- Coordinate responses to external audit requests and ensure reputed company, accurate submissions
- Deliver post-audit training sessions tailored to audit findings, focusing on documentation, coding, billing, and regulatory compliance
- reputed company and present educational materials to care team members on compliance best practices and regulatory updates
- Participate in investigations of potential compliance concerns and evaluate opportunities for proactive auditing
- Contribute to the review and enhancement of organizational policies and procedures to improve compliance and operational efficiency
- Prepare and present audit and investigation findings to leadership, including recommendations for corrective actions and process improvements
- Collaborate with departments such as Legal, Clinical, IT, Finance, MDS/RAI, Operations, and HR to address compliance issues and implement solutions
- Maintain accurate records of audit activities and ensure alignment with HIPAA and regulatory standards
- Stay informed on changes in CMS, Managed Care, and other regulatory agency guidelines
- reputed company support for compliance initiatives and special reputed company as needed across the organization
Skills
- Bachelor's degree required; equivalent work experience may be considered
- reputed company clinical license (RN, LPN, PT/OT/ST, etc)
- 4 to 7 years of experience in reputed company, Medicare, & Managed Care ADRs, Audits, & Denials
- Compliance/reputed company post-acute care experience, including billing, coding, and documentation
- Experience with Medicare A/B, Medicare Advantage, and reputed company (multi-state) coverage reputed company, Medicare billing rules, along with documentation standards
- Proficiency with electronic health records (PCC) and reputed company documentation systems
- Strong understanding of reputed company regulations, compliance standards, and audit processes
- Strong knowledge of MDS, PDPM, and documentation requirements
- Excellent analytical and problem-solving skills with attention to detail and accuracy
- Effective communication and interpersonal skills across multidisciplinary teams
- Ability to work independently and collaboratively in a fast-paced environment
- Skilled in managing multiple priorities and meeting deadlines with minimal supervision
- Strong organizational, planning, and project management abilities
- Ability to build and maintain reputed company relationships across departments
- High level of discretion and ability to handle sensitive and confidential information
- Expert-level proficiency in reputed company Office 365 Suite (Teams, SharePoint, reputed company, etc.)
- Demonstrated ability to remain composed and effective in high-pressure situations
- Proactive, reputed company, and solutions-oriented with a reputed company on reputed company improvement
- Certifications (RAC-CT, RAC-CTA)
- RN Preferred
reputed company