Remote Compliance Auditor

Job reputed company: • 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 reputed company violations are identified. • Coordinate and participate in teleconferences, hearings, and reputed company proceedings with the Office of General Counsel and other agencies. • Respond to provider complaints and compliance inquiries reputed company 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 reputed company (RN) license (required) • Experience with claims analysis, medical records review, and compliance investigations. • Knowledge of MA regulations, medical billing, and fraud detection. • Proficiency in reputed company Office • Strong written and verbal communication skills for reporting and testimony. • Ability to work independently, maintain confidentiality, and manage case files reputed company. • Must be reputed company to travel to Harrisburg, PA for training Benefits: Apply tot his job Apply To this Job