Senior Clinical Compliance Auditor

Workana

2d•Remote

About The Position

Stride Autism Centers is a mission-driven healthcare organization serving children and families across four states in the U.S. Their compliance and clinical quality function supports 23 centers, with a strong focus on audit readiness, documentation quality, and regulatory risk reduction. As a Senior Clinical Compliance Auditor, you will own and operate Stride’s internal audit program, strengthen audit readiness across centers, and support external audit defense behind the scenes. This is a high-trust, detail-intensive remote role for someone who can combine clinical documentation review, compliance rigor, and strong written communication.

Requirements

3–5+ years of experience in U.S. healthcare compliance, clinical auditing, or medical coding/documentation review.
Experience supporting Medicaid and/or MCO audit responses, including records preparation, rebuttal drafting, or appeals support.
Strong knowledge of U.S. Medicaid documentation and medical-necessity standards.
Excellent written English and the ability to produce payer-ready summaries and leadership reports with minimal editing.
Demonstrated ability to track CPT, coding-guideline, and payer policy changes and turn them into operational updates.
Proficiency with EHR or practice-management systems and data tools for sampling, error-rate tracking, and reporting.
Strong integrity, discretion, and HIPAA compliance when handling PHI.
Ability to work remotely with at least 4 hours of overlap with U.S. Central Time.

Nice To Haves

CPC, COC, CPMA, or CHC certification.
Experience in a U.S. healthcare RCM, coding, or audit services environment.
ABA compliance or auditing experience, especially with CPT 97151–97158.
Experience with multi-state Medicaid and major MCOs, including Centene/Iowa Total Care and Molina.
Experience with CentralReach and automated chart-auditing platforms such as Brellium.

Responsibilities

Design and execute a recurring internal audit program, including pre-bill and post-bill chart reviews, monthly sampling, and targeted audits triggered by risk signals.
Audit ABA clinical documentation against payer and state Medicaid requirements, including session notes, treatment plans, reassessments, prior authorizations, supervision rules, rendering-provider accuracy, and time/unit documentation.
Calculate and trend center- and provider-level error rates, identify root causes, and surface documentation gaps before payers do.
Maintain a four-state requirements matrix covering Iowa, Illinois, Nebraska, and South Dakota, and keep it current as regulations and payer rules change.
Own configuration and day-to-day operation of the Brellium audit platform, including AI-flag review, rule-set management, and reporting.
Build audit dashboards and KPIs for leadership and operational teams.
Monitor coding and payer policy changes, including upcoming CPT updates, and translate them into updated templates, workflows, training, and audit rules.
Maintain a centralized audit log and support external audit defense by assembling records-request packets, drafting rebuttal and appeal content, and tracking deadlines and financial exposure.
Draft corrective action plans, training materials, job aids, and documentation examples to support clinical teams and drive measurable improvement.
Partner closely with Revenue Cycle, Compliance, DCOs, BCBAs, center leadership, and IT in a mostly asynchronous environment.