Compliance Auditor Senior

Location: Remote, work from home in Pennsylvania, United States

Company

hirify.global operates healthcare and health insurance organizations, including Allegheny Health Network.

What you will do

• Establish and oversee orientation for AHN audit compliance team members and evaluate auditor progress.
• Guide staff auditors on audit approaches, topics, reports, and analysis.
• Conduct complex clinical, physician, documentation, coding, billing, and medical necessity audits.
• Audit and oversee the 340B program, analyze PEPPER reports, and recommend high-risk areas for review.
• Prepare concise audit reports, develop corrective action plans, and educate physicians, managers, and hospital personnel.
• Respond to government and payer audits and support appeals involving medical necessity, coding, billing, and documentation.

Requirements

• Bachelor’s degree in nursing for the Clinical Specialty track, or a bachelor’s degree/equivalent education and related experience for the Clinical and Physician Specialty tracks.
• Seven years of experience in utilization review, case management, or hospital/physician coding and documentation audits or reviews.
• Experience with medical necessity denials and appeals.
• Knowledge of clinical specialty areas, practices, procedures, and the 340B program.
• Physician Specialty candidates may have RHIT or RHIA certification; a master’s degree is preferred for the Clinical Specialty track.
• Must work remotely from Pennsylvania, United States.

Culture & Benefits

• Work-from-home position supporting hospital and physician compliance programs.
• Work includes collaboration with senior management, physicians, utilization review and case management teams, and operational owners.
• Responsibilities require adherence to HIPAA, privacy, information security, federal and state regulations, and the company’s code of business conduct.