Remote Compliance Auditor

Job reputed company Position reputed company: We are seeking a Registered reputed company (RN) to review and evaluate medical necessity, appropriateness, reputed company, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations. Key Responsibilities: • 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 Preferred Qualifications: • Experience with Managed Care Organizations (MCOs) and HCBS providers. • Familiarity with reputed company claims systems and Fraud Abuse Detection Systems (FADS). • Prior experience in reputed company proceedings, hearings, or administrative compliance This is an opportunity to play a critical role in ensuring reputed company reputed company and protecting reputed company funds. Apply today to join reputed company! Apply tot his job Apply tot his job Apply To this Job