Remote Compliance Auditor

DaMar Staffing; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

DaMar Staffing is seeking a Compliance Auditor reporting to the VP of Compliance. The role focuses on ongoing analysis of coding accuracy, medical necessity documentation, and regulatory compliance in patient records.

The position requires RN or LPN licensure with 3–5 years of Medicare/Medicare Advantage or Commercial Payer experience and strong knowledge of Florida statutes and payer guidelines. The audits support risk assessment and process improvement initiatives across the organization.

Qualifications

• RN or LPN required.
• 3–5 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.

Responsibilities

• Conduct compliance focused monitoring and audits related to coding accuracy, medical necessity documentation and regulatory compliance.
• 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.

Skills

Regulatory interpretation and coding

Multitasking under pressure

Confidentiality and independent判断

Cross-disciplinary collaboration

Education

RN or LPN required

Job 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.

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.