Lead complex hospital and professional billing compliance audits and investigations to identify risks and ensure regulatory alignment.
Analyze billing, coding, and operational data to uncover systemic issues and provide actionable recommendations to leadership.
Serve as a billing compliance subject matter expert, advising cross-functional teams and developing training and policies.
The company is a healthcare organization focused on billing compliance and risk management, providing auditing and advisory services. It offers a remote-first collaborative environment with opportunities to influence policies and work with senior leaders.
Own the systems that keep Daymark's clinical quality and safety program credible as it scales, including audits and incident investigations.
Partner with clinical leadership to embed quality standards into daily workflows, not layered on top.
Manage external audits and regulatory reviews, and provide clear-eyed analysis when issues arise.
Daymark Health is a value-based oncology company redefining the cancer care experience for patients, providers, and health plans. It is a growing company backed by leading venture capital firms, with a collaborative culture focused on transforming cancer care.
Conduct fraud, waste, and abuse investigations and audits.
Prepare reports and correspondence of a confidential nature.
Assist in developing FWA program documentation and training.
CareOregon is a nonprofit, mission-driven health plan focused on providing care to low-income Oregonians. They offer a comprehensive benefits package and emphasize equity, diversity, and inclusion.
Manage governance forums, agendas, decision logs, and action tracking.
Support execution of strategic compliance priorities and monitor cross-functional dependencies.
Coordinate departmental KPIs and executive dashboarding.
HealthEdge is a healthcare technology company that provides software solutions for health plans and payers. The company fosters a culture of accountability, transparency, and compliance, operating remotely across the US.
Evaluate Medicare regulatory requirements and CMS guidance to assess compliance risks for government contracts.
Serve as a subject matter expert to ensure regulatory requirements are implemented accurately and timely across operations and partners.
Collaborate with stakeholders to develop and monitor mitigation strategies for compliance risks and issues.
HCSC expands access to high-quality, cost-effective health care and equips members with tools for better decisions. As an industry leader, they have over 80 years of experience and offer compelling careers in a collaborative, innovative environment.
Investigate complex credit reporting disputes and SCRA determinations, bringing stakeholders together for broader input.
Translate new state legislation into actionable compliance guidance and lead quarterly monitoring and testing.
Serve as subject matter expert on consumer protection laws, shaping policies and controls as the company scales.
Reprise Financial simplifies personal loans, making them accessible and transparent with loans up to $25,000. The company values innovation and collaboration, providing tools and support for employees in a customer-focused environment.
Drive the master project work plan for TJC Behavioral Health accreditation readiness, establishing clear milestones across clinical and operational teams.
Conduct gap analyses and risk mitigation, proactively updating the roadmap and implementing strategies to address compliance risks.
Organize internal mock audits and readiness drills, ensuring operational teams are fully prepared for survey execution.
Lyra Health is a leading provider of evidence-based mental health care, serving more than 20 million people globally. The company has delivered more than 15 million sessions of care and fosters a culture of innovation and impact.
Provides leadership and oversight of oncology clinical research billing compliance, ensuring accurate billing practices.
Optimizes standardized billing compliance framework and directs work of CTMS Specialists and Billing Specialists.
Manages operational workflows including CTMS calendar development and Epic research billing protocol configuration.
The Knight Cancer Clinical Research organization supports translational clinical research to improve lives of people with cancer. OHSU is Oregon's only public academic health center and Portland's largest employer, focusing on patient care, research, and training.
Develop, implement, and maintain compliance policies and procedures aligned with governmental requirements and contractual obligations.
Research compliance questions and regulatory issues, analyze impacts, and recommend corrective actions.
Prepare metrics, reports, and presentations for leadership to support compliance monitoring and business decisions.
Jobgether uses an AI-powered matching process to connect candidates with hiring companies. They are a recruitment platform that processes applications and shares top-fitting candidates directly with employers.
Monitor operational activities for compliance with healthcare policies and established procedures
Support compliance reviews of billing, coding, claims, and documentation processes
Assist with internal audits, compliance assessments, and corrective action plans
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. The company's size and culture are not specified in the posting.
Execute established monitoring programs across calls, omni-channel interactions, and case/eligibility documentation within CRM platforms.
Apply and govern monitoring standards, audit criteria, sampling methodologies, and documentation requirements to ensure consistency and control.
Oversee compliance monitoring to verify adherence to policies, privacy/data protection requirements, and AE/PTC reporting standards.
Novartis is a pharmaceutical company focused on improving lives through innovative science. With a large global workforce, the company emphasizes collaboration, learning, and community.
Lead and oversee Suspicious Activity Monitoring (SAM) case investigations, ensuring BSA/AML regulatory compliance.
Manage operational performance, including case volumes, aging, quality, and regulatory responsiveness.
Partner with senior leadership to develop strategies that enhance the Financial Crime Compliance program.
Pathward is a financial empowerment company that works with innovators to increase financial availability, choice, and opportunity for all. The company is a diverse team of problem solvers and innovators, operating as a hybrid remote-office organization with onsite locations across the US.
Support the Chief Compliance Officer in developing and monitoring the Compliance Work Plan, including auditing and monitoring activities.
Manage intake, tracking, review, and response to governmental revenue cycle investigations and serve as the compliance resource for revenue cycle and operational leaders.
Develop and deliver role-based compliance training, translate regulatory changes into actionable policies, and monitor audit results to create corrective action plans.
UnityPoint Health is a healthcare organization providing comprehensive services across multiple states. Recognized as a Top 150 Place to Work in Healthcare, they are committed to team members and foster a culture of belonging.
Set the strategic direction for Compliance Operations, transforming regulatory requirements into scalable practices that enable growth.
Partner with Product and Engineering to build tech-first, automated solutions that reduce manual effort and scale operations.
Lead state licensing audits, develop key compliance metrics, and build a high-performing team of 5-10 professionals.
Honor Technology is changing how society cares for older adults by providing technology, tools, and services that empower them to live life on their own terms. With over 100,000 Care Pros and a global franchise network, the company delivers over 50 million hours of personalized care annually, fostering a culture of innovation and compassion.
Own the compliance strategy and risk assessment for the business, including regulatory, corporate, and clinical compliance.
Build government programs compliance capability, including Medicare marketing and member communication requirements.
Partner with clinical, product, operations, data, and payer teams to embed compliance into new workflows, AI tools, and market expansions.
Chamber is rebuilding the system for cardiology by partnering with independent cardiologists to improve outcomes through technology, data, and operational tools. As an early-stage company, they value low ego, empathy, courage, ownership, and grit, fostering a culture of innovation and human-centered care.
Lead the application of the Clinical Quality Management Regime across Delivery Partners, ensuring compliance with contractual quality standards.
Use quality intelligence and performance data to assess effectiveness of controls and identify emerging risks.
Provide hands-on clinical quality expertise to diagnose performance issues and support corrective actions.
Ingeus is a leading human services provider that helps people, businesses, and communities thrive through employment, skills, and health & wellbeing services. It is a trusted partner to government and industry, committed to creating positive social impact, and fosters an inclusive culture treating everyone with dignity.
Lead portions of regulatory assessments, external audits, and accreditation processes for Commercial, Medicare, Medicaid, and Marketplace departments.
Act as primary point of contact for internal and external partners on regulatory activity, quality efforts, SOP development, and client delegation agreements.
Maintain regulatory gap status reporting, track work streams, and lead change management related to regulatory requirements.
Prime Therapeutics is a pharmacy benefit manager (PBM) with a purpose beyond profits, reimagining pharmacy solutions to connect care for those they serve. The company is a large, purpose-driven organization focused on simplifying healthcare and fostering a collaborative culture.
Initiate and manage compliance onboarding for healthcare contractors, including credentialing verification.
Collaborate with staffing agencies and internal stakeholders to meet compliance deadlines.
Monitor credential expirations and maintain accurate records in the Vendor Management System.
Trio Workforce Solutions helps healthcare organizations manage workforce challenges through technology and services. The company is a mission-driven organization with a collaborative culture and growth opportunities nationwide.
Support clinical process improvement initiatives and monitor performance to client SLAs.
Conduct root cause analyses and develop remediation plans for process variations.
Collaborate with product and analytics teams to optimize letters and template tracking.
Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans and providers to optimize care quality and reduce costs. The company has been named to the Inc. 5000 list and ranked a Top 5 LinkedIn Startup, backed by leading investors, with a culture that values empathy and collaboration.
Identify and investigate potential healthcare fraud, waste, and abuse through data analysis and claims review.
Proactively monitor provider activity to detect patterns, anomalies, and emerging trends.
Utilize Excel (advanced proficiency required) and other tools to support investigations and legal proceedings.
Cotiviti is a healthcare analytics company that detects and prevents fraud, waste, and abuse through data-driven solutions. The company offers a competitive benefits package and supports a work-at-home culture with a focus on investigation and compliance.