Senior Clinical Compliance Auditor

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Workana

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2012

👥 RH Tech

🏪 Marketplace

🎯 Recrutamento

💰 Series C em 2024-02

HR Tech • Marketplace • Recruitment

A Workana é uma plataforma líder na América Latina que conecta empresas a talentos remotos em diversas disciplinas. Com mais de uma década de atuação no mercado, a Workana é especializada em fornecer às empresas desenvolvedores e freelancers pré-selecionados e certificados, para períodos determinados ou demandas por projeto. A plataforma possibilita contratações em áreas como TI & Programação, Design & Multimídia, Redação & Tradução, entre outras, oferecendo flexibilidade de pagamento em moedas locais ou em USD. A Workana assegura tranquilidade com pagamentos protegidos e garantia de satisfação, ajudando as empresas a crescer de forma rápida e sustentável ao aproveitar o melhor talento remoto disponível.

Descrição

• Design and execute a recurring internal audit program, including pre-bill and post-bill chart reviews, monthly sampling, and targeted audits triggered by risk signals. • Audit ABA clinical documentation against payer and state Medicaid requirements, including session notes, treatment plans, reassessments, prior authorizations, supervision rules, rendering-provider accuracy, and time/unit documentation. • Calculate and trend center- and provider-level error rates, identify root causes, and surface documentation gaps before payers do. • Maintain a four-state requirements matrix covering Iowa, Illinois, Nebraska, and South Dakota, and keep it current as regulations and payer rules change. • Own configuration and day-to-day operation of the Brellium audit platform, including AI-flag review, rule-set management, and reporting. • Build audit dashboards and KPIs for leadership and operational teams. • Monitor coding and payer policy changes, including upcoming CPT updates, and translate them into updated templates, workflows, training, and audit rules. • Maintain a centralized audit log and support external audit defense by assembling records-request packets, drafting rebuttal and appeal content, and tracking deadlines and financial exposure. • Draft corrective action plans, training materials, job aids, and documentation examples to support clinical teams and drive measurable improvement. • Partner closely with Revenue Cycle, Compliance, DCOs, BCBAs, center leadership, and IT in a mostly asynchronous environment.

🎯 Requisitos

• 3–5+ years of experience in U.S. healthcare compliance, clinical auditing, or medical coding/documentation review. • Experience supporting Medicaid and/or MCO audit responses, including records preparation, rebuttal drafting, or appeals support. • Strong knowledge of U.S. Medicaid documentation and medical-necessity standards. • Excellent written English and the ability to produce payer-ready summaries and leadership reports with minimal editing. • Demonstrated ability to track CPT, coding-guideline, and payer policy changes and turn them into operational updates. • Proficiency with EHR or practice-management systems and data tools for sampling, error-rate tracking, and reporting. • Strong integrity, discretion, and HIPAA compliance when handling PHI. • Ability to work remotely with at least 4 hours of overlap with U.S. Central Time.

🏖️ Benefícios

• Compensation in USD. • Fully remote work • High-growth opportunities in an international company.