Senior Clinical Compliance Auditor

Accountabilities: The Senior Clinical Compliance Auditor will be responsible for designing, managing, and improving clinical audit processes while ensuring documentation accuracy, regulatory alignment, and operational excellence. This role requires strong attention to detail, independent problem-solving, and the ability to collaborate with clinical, operational, and compliance stakeholders.

Design and execute recurring internal audit programs, including pre-bill and post-bill reviews, monthly sampling, and risk-based audits.

Review clinical documentation against healthcare payer and regulatory requirements, including treatment plans, session notes, reassessments, authorizations, supervision requirements, and billing documentation.

Analyze audit results, calculate error rates, identify trends, and provide recommendations to prevent compliance issues.

Maintain and update multi-state regulatory and payer requirement matrices to reflect changing guidelines.

Manage audit platforms and tools, including reviewing AI-generated audit findings, maintaining rules, and improving reporting processes.

Develop dashboards, KPIs, and compliance reports for leadership and operational teams.

Monitor coding updates, payer policy changes, and regulatory developments, translating them into updated workflows, templates, and training materials.

Support external audit preparation by organizing documentation, preparing responses, drafting appeals or rebuttals, and tracking deadlines.

Create corrective action plans, training resources, and documentation guidance to improve clinical compliance.

Collaborate with Revenue Cycle, Compliance, clinical leadership, operations teams, and technology stakeholders in a remote environment.

Requirements:

The ideal candidate will bring strong experience in healthcare compliance, clinical auditing, and documentation review, with the ability to analyze complex requirements and communicate findings clearly to different audiences.

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

Experience supporting Medicaid and/or Managed Care Organization (MCO) audit responses, including documentation preparation, rebuttals, or appeals.

Strong knowledge of U.S. Medicaid documentation standards and medical necessity requirements.

Excellent written English skills, with the ability to prepare professional audit summaries, reports, and compliance documentation.

Experience tracking CPT codes, coding guidelines, and payer policy changes and converting updates into operational improvements.

Proficiency with EHR systems, practice management platforms, and reporting tools used for audit analysis and compliance monitoring.

Strong understanding of HIPAA requirements, confidentiality, and handling of protected health information (PHI).

Strong analytical, organizational, and problem-solving skills with high attention to detail.

Ability to work independently in a remote environment with at least four hours of overlap with U.S. Central Time.

Nice-to-have qualifications:

CPC, COC, CPMA, or CHC certification.

Experience in healthcare revenue cycle management, coding, or audit services.

Experience with ABA compliance or auditing, including CPT codes 97151–97158.

Experience supporting multi-state Medicaid programs and major healthcare payers.

Familiarity with clinical platforms and automated chart auditing solutions.

Benefits:

Competitive compensation paid in USD.

Fully remote work environment.

Opportunity to work with an international and growing organization.

High-impact role supporting healthcare quality and compliance improvements.

Collaborative environment with opportunities for professional growth.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

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