Overview:

Our client is looking for a Senior ABA Compliance & Clinical Audit Specialist (U.S. Medicaid) to serve as the engine of their proactive audit-readiness and internal audit program across 23 centers in IA, IL, NE, and SD. In this role, you will design and run recurring chart reviews, manage the Brellium auditing platform, and produce analytics to ensure continuous compliance with Medicaid and MCO standards. You will also provide vital behind-the-scenes support for external audit defense by preparing records-request packets, drafting rebuttals, and tracking financial exposure. This is a high-trust remote position requiring meticulous attention to detail and a commitment to safeguarding services for children and families.

Schedule: Monday to Friday, 8:00 am to 5:00 pm (US Central Time, 40 hours per week)

Responsibilities:

Internal Auditing & Audit-Readiness (Primary Mandate)

• Design and execute a recurring internal audit program: pre-bill and post-bill chart reviews, monthly sampling by center, provider, and code, and targeted audits triggered by risk signals
• Audit ABA clinical documentation against payer and state Medicaid requirements — session notes, treatment plans, reassessments, prior authorizations, supervision and concurrent-billing rules, rendering-provider accuracy, and unit/time documentation (CPT 97151–97158)
• Calculate and trend center- and provider-level error rates; identify systemic root causes and documentation gaps before payers do
• Maintain a four-state requirements matrix (IA, IL, NE, SD) capturing each state Medicaid's and MCO's documentation, authorization, and supervision rules — anchored to written policy and regulation, and updated as they change, in coordination with leadership

Brellium Administration & Analytics

• Own configuration, rule-set management, and day-to-day operation of the Brellium platform
• Triage and review AI-flagged charts, validate findings, and convert flags into actionable remediation and trend reporting
• Build and maintain audit dashboards and KPIs for leadership and DCO teams

Coding Policy Monitoring & Change Readiness

• Monitor AMA CPT and payer coding policy developments from the proposal stage forward — including the new adaptive behavior services codes slated for 2027 — rather than waiting for official release, so we have a runway to prepare and pivot
• Track proposed and finalized changes to coding guidelines, payer billing policies, and state Medicaid coding guidance across IA, IL, NE, and SD; summarize impact for the Compliance Officer, Revenue Cycle, and clinical leadership as changes move toward adoption
• Translate upcoming coding and guideline changes into updated documentation templates, CentralReach workflows, internal audit rule sets (including Brellium), and training content — ready before effective dates, not after
• Maintain a forward-looking change calendar of pending coding, guideline, and policy effective dates, integrated with the four-state requirements matrix

External Audit Support

• Note: the Compliance Officer is the named point of contact for all payers, regulators, and external counsel and leads all external communication. This role supports that defense from behind the scenes
• Maintain the centralized audit log tracking every request, deadline, and deliverable across all open Medicaid, MCO, RAC, UPIC, and commercial payer audits
• Assemble complete, accurate records-request response packets for Compliance Officer review and submission — on time, every time
• Draft rebuttal and appeal content (documentation and medical-necessity arguments, regulatory citations, exhibit organization) for Compliance Officer review, revision, and signature
• Quantify and track financial exposure and recovery across open audits; prepare status and risk reporting for the Compliance Officer and COO on a defined cadence

Corrective Action & Education Support

• Draft corrective action plans (CAPs) for identified deficiencies and track them to verified closure; onshore clinical leadership owns delivery of feedback and training
• Produce targeted documentation training content, job aids, and examples for BCBAs, DCOs, and center leadership — framed as clinical quality improvement, not punitive enforcement
• Translate audit findings into recommended updates to documentation standards, templates, and CentralReach workflows

Cross-Functional Collaboration

• Partner with Revenue Cycle on denial trends, authorization integrity, and clean-claim documentation
• Support the Compliance Officer on broader program needs (policy research, risk assessment, regulatory monitoring)
• Communicate clearly and proactively in a largely asynchronous environment: written summaries, flagged risks, and no surprises

Data Security & PHI Handling Requirements

• All work performed on a company-managed or company-controlled device enrolled in our MDM, with SSO/MFA authentication; no personal devices
• PHI is accessed only through approved systems; no local downloads, printing, screenshots, or transfer of PHI to personal storage, email, or messaging tools
• Work is performed from a private, secure workspace; PHI must not be visible or audible to others
• Completion of our HIPAA and security training before system access, with annual recertification; compliance with all applicable business associate and data-handling agreements
• Immediate reporting of any suspected privacy or security incident

Must-Have Requirements:

• Bachelor's degree or equivalent experience
• 3–5+ years in U.S. healthcare compliance, clinical auditing, or medical coding/documentation review — including work supporting U.S. Medicaid and/or MCO audit responses (records preparation, rebuttal drafting, or appeals support)
• Strong command of U.S. Medicaid documentation and medical-necessity standards; working knowledge of the audit and appeals lifecycle (records requests, rebuttals, recoupments, extrapolation)
• Exceptional written English: able to produce payer-ready audit summaries, rebuttal drafts, and leadership reporting that require minimal editing
• Demonstrated habit of tracking CPT, coding-guideline, and payer policy changes — including proposed changes ahead of official release — and translating them into operational updates
• Proficiency with EHR/practice-management systems and data tools for sampling, error-rate tracking, and reporting
• High integrity and discretion handling PHI; thorough understanding of HIPAA and demonstrated history of compliant remote PHI handling
• Reliable ability to work a schedule with at least 4 hours of daily overlap with U.S. Central Time

Nice-to-Have Requirements:

• Certification such as CPC/COC, CPMA (AAPC), or CHC
• Experience in a U.S. healthcare RCM, coding, or audit services environment serving U.S. provider organizations
• ABA-specific compliance/auditing experience and fluency with CPT 97151–97158, including supervision and concurrent-billing distinctions (97155 vs. 97153)
• Multi-state Medicaid exposure (IA, IL, NE, SD; Centene/Iowa Total Care, Molina, and comparable MCOs)
• CentralReach experience; experience with automated chart-auditing platforms (Brellium or comparable)

Independent Contractor Perks:

• Permanent work from home
• Immediate hiring
• Health insurance coverage for eligible locations

Note:

Please click the Apply button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.

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