Compliance and Audit Specialist (Healthcare)

TL;DR

Compliance and Audit Specialist (Healthcare): Monitoring adherence to federal, state, and local healthcare regulations, conducting audits and investigations, and supporting policy development with an accent on fraud and abuse laws, billing/coding practices, and HIPAA compliance. Focus on identifying risks, analyzing audit findings, delivering targeted training, and collaborating with clinical and operational teams to ensure regulatory compliance in virtual care operations.

Location: Remote

Salary: $90,000-$120,000

Company

AI-powered virtual healthcare clinic combining advanced AI systems with licensed physician oversight to make high-quality care more affordable and accessible.

What you will do

• Monitor regulatory changes from CMS, OIG, OCR and conduct risk assessments to identify vulnerabilities and recommend actions.
• Plan and execute internal audits on clinical documentation, billing, coding, referrals, and workflows; analyze findings and track resolutions.
• Investigate compliance concerns, hotline reports, and violations; handle self-disclosures and refunds.
• Draft and update compliance policies, procedures, and training materials on HIPAA, fraud/abuse, documentation, and code of conduct.
• Collaborate with clinical, operational, legal, product, and HR teams; participate in compliance committees.

Requirements

• Bachelor's degree in Healthcare Administration, Health Information Management, Nursing, Business Administration, Public Health, or related field.
• One or more certifications: CHC, CHPC, CPCO (or obtain within 12 months); CCS/CPC a plus.
• 3–5 years in healthcare compliance, regulatory affairs, coding/billing auditing.
• Experience conducting audits and investigations; knowledge of Medicare/Medicaid billing, CPT/ICD-10, payer requirements.
• Strong understanding of fraud/abuse laws (Anti-Kickback, Stark, False Claims Act), HIPAA, EMTALA, CMS rules.
• Proficiency in Microsoft Office; analytical, communication, and project management skills.

Nice to have

• Master's degree in related field.
• Experience in multi-site clinics or health systems; familiarity with EHR (Epic, Athenahealth) and billing platforms.
• Knowledge of OIG guidance for physician practices and state-specific regulations.

Culture & Benefits

• Comprehensive medical/dental/vision coverage, 401k employer match, annual CME reimbursement.
• Standard business hours with occasional flexibility for deadlines.
• Commitment to diversity, inclusion, and mission-driven culture with transparent, non-negotiable compensation.