{"id":2439512,"url":"https://alion.io/job/theckhobbiegroup-remote-compliance-auditor","title":"Remote Compliance Auditor","company":{"id":4423801,"name":"The CK Hobbie Group","domain":"theckhobbiegroup.com","url":"https://alion.io/company/theckhobbiegroup","size_band":"51-200","is_staffing_agency":true,"employer_type":"agency","is_intermediary":false,"listed_via":null,"ats_vendor":"Zoho Recruit","truth_index":null},"role":"Finance","role_family":"Finance","seniority":null,"employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Harrisburg, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":60000,"max_usd":156000,"period":"year","method":"role_country_seniority_unknown","sample_n":12606},"experience_years_min":null,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false}],"status":"live","first_seen_at":"2026-10-13T11:42:35Z","employer_posted_date":"2026-10-13","last_verified_at":"2026-10-26T14:44:32Z","board_verified":true,"closed_at":null,"days_open":13,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":13},"description":"Position Overview:\nWe are seeking a Registered Nurse (RN) to review and evaluate medical necessity, appropriateness, quality, and compliance of services rendered by providers. This role involves claims analysis, provider audits, fraud detection, and regulatory enforcement to ensure compliance with state and federal regulations.\nKey Responsibilities:\nAnalyze claims data, medical records, and provider documentation to identify discrepancies, fraud, or non-compliance.\nConduct retrospective case reviews, on-site provider audits, and recipient interviews.\nReview billing practices for upcoding, duplicate billing, and unbundling of services using ICD-10, CPT, and HCPCS manuals.\nPrepare reports, case findings, and recommend sanctions when violations are identified.\nCoordinate and participate in teleconferences, hearings, and legal proceedings with the Office of General Counsel and other agencies.\nRespond to provider complaints and compliance inquiries via hotline, email, and official reports.\nMaintain case tracking systems and contribute to policy recommendations and process improvements.\nTravel as needed for on-site reviews, meetings, and training.\nRequirements:\nRegistered Nurse (RN) license (required).\nExperience with claims analysis, medical records review, and compliance investigations.\nKnowledge of MA regulations, medical billing, and fraud detection.\nProficiency in Microsoft Office \nStrong written and verbal communication skills for reporting and testimony.\nAbility to work independently, maintain confidentiality, and manage case files efficiently.\nMust be able to travel to Harrisburg, PA for training\nPreferred Qualifications:\nExperience with Managed Care Organizations (MCOs) and HCBS providers.\nFamiliarity with PROMISe claims systems and Fraud Abuse Detection Systems (FADS).\nPrior experience in legal proceedings, hearings, or administrative compliance\nThis is an opportunity to play a critical role in ensuring healthcare integrity and protecting public funds. Apply today to join our team!","description_format":"text","description_chars":2020,"description_truncated":false,"requirements":{"experience_years_min":null,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":[],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":[],"lifecycle":[{"event":"open","at":"2026-10-13T11:42:35Z"}],"visa":[],"liveness":{"score":42,"band":"fade","label":"Fading","p_open":1,"p_active":0.472,"p_room":0.9,"age_days":12,"expected_fill_days":30,"reasons":["conf:0","agency","win:mid"],"computed_at":"2026-10-26T05:57:25Z"},"pay":null,"html_url":"https://alion.io/job/theckhobbiegroup-remote-compliance-auditor","json_url":"https://alion.io/job/theckhobbiegroup-remote-compliance-auditor.json","meta":{"generated_at":"2026-10-26T14:59:54Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":19875,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-27T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4423801},"rest":"https://alion.io/mcp/rest/get_company?id=4423801"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Ftheckhobbiegroup-remote-compliance-auditor"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Ftheckhobbiegroup-remote-compliance-auditor"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Ftheckhobbiegroup-remote-compliance-auditor"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/theckhobbiegroup-remote-compliance-auditor\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Ftheckhobbiegroup-remote-compliance-auditor"}]}