Remote Compliance Auditor

Job not on LinkedIn

March 11

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

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The CKHobbie Group

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HR Tech • Recruitment • Staffing

The CKHobbie Group is a staffing firm that has been providing employment solutions for over 50 years. Based in Allentown, PA, the company specializes in matching qualified individuals with job opportunities across various sectors, including manufacturing, logistics, and healthcare. The CKHobbie Group believes that the right people are an employer's strongest asset and focuses on enhancing client productivity through effective talent acquisition and staffing services.

11 - 50 employees

Founded 1970

👥 HR Tech

🎯 Recruiter

📋 Description

• Analyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance. • Conduct retrospective case reviews, on-site provider audits, and recipient interviews. • Review billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals. • Prepare reports, case findings, and recommend sanctions when violations are identified. • Coordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies. • Respond to provider complaints and compliance inquiries via hotline, email, and official reports. • Maintain case tracking systems and contribute to policy recommendations and process improvements. • Travel as needed for on-site reviews, meetings, and training.

🎯 Requirements

• Registered Nurse (RN) license (required) • Experience with claims analysis, medical records review, and compliance investigations. • Knowledge of MA regulations, medical billing, and fraud detection. • Proficiency in Microsoft Office • Strong written and verbal communication skills for reporting and testimony. • Ability to work independently, maintain confidentiality, and manage case files efficiently. • Must be able to travel to Harrisburg, PA for training