Remote Healthcare Policy & Audit Content Analyst

Jobgether; United States; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Fully remote

Salary range 85k–110k

Medical coverage

Dental & vision

401(k) matching

Tuition reimbursement

FSA/HSA options

Wellness perks

Digital-first environment

Career growth

Job summary

Jobgether seeks a seasoned Audit Concepts professional to develop and maintain audit frameworks across Medicaid, Medicare, and commercial programs. You will review coding guidelines, apply payer rules, and document findings to ensure compliant, scalable concepts.

Ideal candidates have 3+ years in healthcare payment integrity, strong Medicare knowledge, and proficiency in AI/automation. This fully remote US role offers competitive compensation and opportunities for impact across multiple programs.

Qualifications

• At least three years of healthcare payment integrity or related field.
• Active RHIA/RHIT/CCS/CPC/CPMA or RN/LPN license.
• Ability to interpret complex healthcare regulations and payer guidelines.
• Strong Medicare and commercial coding knowledge.
• Experience with claims and reimbursement processes.
• Knowledge of facility reimbursement methodologies.
• Analytical and research capabilities.
• Technical documentation skills.
• AI and automation proficiency.
• Microsoft Office proficiency.
• Excellent communication and collaboration.
• Organizational and prioritization skills.
• Remote work readiness: fully remote in the United States.

Responsibilities

• Develop and maintain audit concepts per schedule and client needs.
• Research regulatory and coding requirements and document findings.
• Apply client-specific reimbursement rules and contractual requirements.
• Interpret state Medicare/Medicaid manuals and regional policies.
• Identify new audit opportunities based on payer policies and trends.
• Support Medicaid, Medicare, and commercial programs across audits.
• Maintain alignment with CMS guidance, MUEs, CPT/HCPCS.
• Develop coding unbundling audits per NCCI edits.
• Analyze audit performance and drive root-cause improvements.
• Benchmark results against standards and client baselines.
• Validate automated audit logic before deployment.
• Ensure pre-deployment accuracy of audit concepts.
• Promote consistent policy application across platforms.
• Collaborate on payment integrity initiatives with teams.
• Improve workflows, documentation, and cross-functional coordination.
• Leverage AI tools to accelerate policy research.
• Support additional business priorities as needed.

Skills

Regulatory interpretation

Healthcare payment integrity

Audit concepts

Policy research

Medicare rules

Coding guidelines

Data analysis

AI/Automation

Communication skills

Remote collaboration

Education

RHIA

RHIT

CCS

CPC

CPMA

RN/LPN license

Tools

Excel

Word

PowerPoint

SharePoint

Teams

Job description

Jobgether seeks a seasoned Audit Concepts professional to develop and maintain audit frameworks across Medicaid, Medicare, and commercial programs. You will review coding guidelines, apply payer rules, and document findings to ensure compliant, scalable concepts.

Ideal candidates have 3+ years in healthcare payment integrity, strong Medicare knowledge, and proficiency in AI/automation. This fully remote US role offers competitive compensation and opportunities for impact across multiple programs.