Compliance Specialist

Insight Global; Birmingham (AL); In loco; USD 55.000 - 85.000; Tempo pieno

Descrizione del lavoro

Insight Global is seeking an internal auditor to manage external payor audits in Birmingham, AL. The role involves coordinating audit requests, collecting and reviewing documentation, and communicating with payers to resolve findings.

The ideal candidate has a bachelor's degree in a related field and about two years of related experience, with strong analytical and Excel skills to support compliance and process improvements.

Competenze

• Bachelor's degree in a related field; two years of related audit or compliance experience preferred.
• Experience with audit tracking and reporting tools.
• Strong analytical, organizational, and communication skills.
• Proficient in Excel and audit tracking tools.

Mansioni

• Manages assigned external commercial payor audits throughout the audit lifecycle, including intake, review, tracking, submission, determination, appeal, and closure activities.
• Reviews audit requests to determine documentation requirements, deadlines, scope of review, and applicable payer guidelines.
• Monitors appeal status and payer determinations to ensure timely follow-up and resolution.
• Coordinates with internal stakeholders to obtain supporting medical and billing documentation.
• Ensures audit activities comply with policies, payer requirements, and regulatory standards.
• Maintains audit inventories and tracking logs, documenting status, outcomes, and financial impact.
• Assists with audit-related process improvements and policy development.
• Performs other duties as assigned.

Conoscenze

Auditing

Regulatory compliance

Attention to detail

Analytical skills

Communication

Formazione

Bachelor's degree in related field

2 years related experience preferred

Strumenti

Excel

Audit tracking tools

Descrizione del lavoro

To perform internal audits to ensure regulatory compliance in an assigned area. To support the management and resolution of external commercial payor audits by coordinating audit requests, reviewing findings, facilitating payer communications, preparing appeals, tracking outcomes, and ensuring timely completion of audit activities.

Key Duties & Responsibilities

• Manages assigned external commercial payor audits throughout the audit lifecycle, including intake, review, tracking, submission, determination, appeal, and closure activities. Reports results to upper management.
• Reviews audit requests to determine documentation requirements, deadlines, scope of review, and applicable payer guidelines.
• Monitors appeal status and payer determinations to ensure timely follow-up, escalation, and resolution of outstanding audit cases.
• Coordinates with internal stakeholders to obtain supporting medical and billing documentation necessary for audit responses and appeals.
• Ensures audit activities are handled in accordance with organizational policies, payer requirements, regulatory standards, and established audit management procedures.
• Maintains accurate audit inventories and tracking logs, documenting status, outcomes, financial impact, and appeal activity.
• Assists with audit-related process improvement initiatives and policy development.
• Performs other duties as assigned.

Bachelor's degree in a related field and two (2) years of related experience preferred. Equivalent combinations of education, relevant healthcare audit, revenue cycle, compliance, or appeals experience will be considered.

Preferred Qualifications

• Experience with audit tracking and reporting tools.
• Strong analytical, organizational, and communication skills.
• Proficiency with Microsoft Excel and audit tracking tools.