Remote Compliance Auditor

DaMar Staffing; Miami (FL); Remote; USD 70,000 - 90,000; Full time

Job summary

DaMar Staffing in Miami, FL is seeking a Compliance Auditor to analyze coding accuracy, medical necessity documentation, and regulatory compliance in patient records.

Reporting to the VP of Compliance, the role conducts audits, maintains metrics, participates in risk reviews, and provides management with audit findings.

RN or LPN with 3–5 years payer experience preferred; knowledge of Florida statutes and payer guidelines is a plus.

Qualifications

• RN or LPN licensure required; compliance auditing preferred.
• 3–5 years of Medicare/Medicaid payer experience preferred.
• Strong knowledge of Florida statutes and payer guidelines preferred.

Responsibilities

• Monitor and audit coding accuracy and medical necessity documentation.
• Conduct ad hoc reviews for high-risk areas.
• Maintain reports, data, metrics, and benchmarking for compliance.
• Participate in committees to address risks and drive improvements.
• Provide management with audit findings and compliance reports.

Skills

Regulatory interpretation

Multi-tasking

Independence & discretion

Cross-functional collaboration

Education

RN/LPN

Experience with payers (3–5 yrs)

Payer/regulations knowledge

Job description

Job Description

Job Description

Description:

POSITION SUMMARY:

Reporting to the VP of Compliance, the Compliance Auditor is responsible for ongoing analysis and review of coding accuracy, medical necessity documentation, and regulatory compliance in patient records.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES:

• Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity, supporting documentation and other operational functions.
• Conducts ad hoc reviews and audits based on high risk, problem prone, or otherwise specified areas.
• Maintains tools, reports, data, metrics, benchmarking, tracking, and trending patient and compliance data.
• Participates in various committees to address risks and opportunities for improvement, to report on compliance data, and collaborate in process improvement initiatives.
• Provide reports to management on compliance metrics and audit findings as requested.

Requirements:

EDUCATION AND QUALIFICATIONS:

• RN or LPN required
• A minimum of three to five years experience in Medicare, Medicare Advantage, and/or Commercial Payers preferred.
• Strong knowledge of Florida statutes, Medicare & Medicaid conditions of participation and payment, and commercial payer guidelines preferred.

SKILLS AND COMPETENCIES:

• Ability to accurately interpret regulations, payment and coding guidelines.
• Ability to manage multiple priorities simultaneously and effectively handle the emotional stress of the workload.
• Ability to work independently exercising confidentiality, discretion and independent judgment.
• Ability to work in collaboration with other disciplines within the organization.