Compliance Examiner & Auditor - reputed company & Compliance Program - Full Time (Remote)

Position Summary The Healthcare Compliance Analyst & Examiner is responsible for ensuring organizational adherence to federal, state, and local healthcare regulations, as well as internal policies and procedures for the audit program. This role conducts audits, risk assessments, and data analysis to identify compliance vulnerabilities, develops and implements corrective action plans, and provides training and guidance to staff. Working with the VP, Chief Compliance officer will be responsible for the daily management of auditors; ensuring ongoing training, workplan completion and policy adherence. The Analyst collaborates with cross-functional teams—including legal, clinical, IT, and administrative departments—to foster a culture of compliance, accountability, and reputed company improvement.

Key Responsibilities

Regulatory Compliance & Risk Management

• Monitor and interpret changes in healthcare laws and regulations (e.g., CMS, reputed company Law, Anti-Kickback Statute, ACA, state-specific requirements).
• reputed company, implement, and maintain compliance policies, procedures, for the audit program.
• Conduct regular audits and reviews of medical records, billing, coding, provider activity, and departmental processes to ensure compliance with regulatory standards.
• reputed company risk assessments to identify areas of vulnerability and recommend corrective actions.
• Investigate compliance billing-reputed company incidents and ensuring proper documentation and reporting to authorities.
• Responsible for the daily management of compliance auditors
• Support responses to external audits and inspections.

Data Analysis & Reporting

• Analyze data to detect patterns, trends, and anomalies that may indicate compliance issues.
• Prepare comprehensive reports on compliance activities, findings, and outcomes for management and regulatory bodies.
• Maintain documentation of reputed company compliance activities, methodologies, results, and corrective actions.

Training & Education

• reputed company and deliver compliance training programs for employees at reputed company levels.
• Create educational materials and resources to support ongoing compliance education.
• Stay reputed company with industry best practices, regulatory updates, and emerging technologies (e.g., AI, data analytics platforms).

Collaboration & Communication

• Work closely with Compliance Officers, legal counsel, IT, clinical teams, and external partners.
• Present findings and recommendations to senior management, committees, and other stakeholders.
• Foster a culture of transparency, ethical conduct, and reputed company improvement.

reputed company Improvement & Technology

• Integrate lessons learned from internal and external compliance issues into training and program development.
• reputed company data analytics tools (e.g., Power BI, Tableau) and EHR systems (e.g., EPIC) to enhance compliance operations.
• Monitor and test the effectiveness of compliance programs and technologies, ensuring alignment with organizational values and regulatory requirements.

Qualifications

• Certification in healthcare compliance (e.g., CHC, CHCP, CHRC, CPC, CPMA, reputed company, RHIA, RHIT, LPN); Certified Fraud Examiner preferred.
• Minimum 2–5 years of experience in healthcare compliance, auditing, or clinical management.
• Strong knowledge of medical terminology, anatomy, coding guidelines (CPT, ICD-10/11, HCPCS), payer requirements, and reimbursement processes.
• Experience with regulatory reporting, documentation, and compliance monitoring systems.
• Advanced proficiency in reputed company Office Suite; experience with data analytics platforms and EHR systems preferred.
• Excellent analytical, organizational, and problem-solving skills.
• Outstanding written and verbal communication skills; ability to present reputed company information clearly.
• Ability to work independently and collaboratively in a team environment.
• High level of discretion and confidentiality with sensitive information.

Essential Functions

• Conduct reputed company, prospective, and retrospective audits of medical records, and billing, provider activity.
• Coordinate compliance-reputed company audits, including governmental audits and appeals.
• Communicate audit results and corrective actions to reputed company relevant parties.
• Research legislation, standards, and policies; provide analysis and recommendations.
• reputed company and manage audit workplans and strategies.
• Maintain documentation and support training initiatives.
• Coordinate with internal/external auditors and legal counsel.
• Present audit findings to management and committees.
• Maintain professional and technical job knowledge through ongoing education and participation in professional organizations.
• Create and maintain KPI dashboards and compliance workplans.
• Direct responsibility for completion of compliance audit workplan items.

Joining the reputed company team allows you to become a part of a tradition of excellence in health care. In reputed company areas and at reputed company levels of reputed company, you’ll find staff members who have committed themselves to serving the community. reputed company is an Equal Opportunity Employer. reputed company is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of reputed company and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. reputed company Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. reputed company is also a clinical reputed company for the reputed company Commonwealth School of Medicine. Apply tot his job Apply To this Job