Healthcare Compliance Specialist

2 days ago


Cebu and Pasig, Philippines Gratitude Philippines Full time
Job Overview

At Gratitude Philippines, we are seeking a seasoned Clinical Auditor to join our team. In this critical role, you will play a pivotal part in ensuring the highest standards of clinical excellence across our organization.

Key Responsibilities:
  • Conduct regular audits of clinical practices, patient records, and healthcare processes to identify areas for improvement.
  • Analyze audit findings and data to pinpoint trends, patterns, and risk areas, providing actionable insights to inform decision-making.
  • Monitor the effectiveness of implemented changes and offer ongoing support to ensure seamless integration.
  • Ensure that our organization remains compliant with all relevant regulatory requirements, upholding the highest standards of accountability and integrity.
  • Develop educational materials and resources to facilitate ongoing staff development, fostering a culture of continuous learning and growth.

Required Skills and Qualifications:
  • We seek a Registered Nurse with CIC/CCS certification and prior auditing/DRG experience, preferably within the US Healthcare sector.
  • Prior experience in medical coding, medical billing, RCM health plan operations is highly desirable.
  • The ideal candidate will possess in-depth knowledge of healthcare claims payment policy and processing, including CMS and Medicaid regulations.
  • Practical clinical experience working in hospitals, offices, or nursing homes is essential.
  • Excellent written and verbal communication skills, along with the ability to think logically and process information sequentially with high accuracy and efficiency.
  • Proficiency in Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.

Benefits:
We offer a competitive compensation package, opportunities for professional growth, and a dynamic work environment that values innovation and collaboration.

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