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We are proud to present the following opportunity.
About Our Client
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.
Role Overview
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.
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.
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 Have
- 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.
Benefits
- Compensation in USD.
- Fully remote work
- High-growth opportunities in an international company.
