Posted today
Near is a recruiting company that connects high-performing professionals across Latin America with remote opportunities at U.S.-based companies. We partner with growing organizations to help them build strong, long-term remote teams while giving Latin American professionals access to competitive international career opportunities.
Our client is a U.S.-based healthcare services organization supporting medically and socially vulnerable populations through community-based healthcare programs.
The organization operates in a highly regulated environment and works closely with healthcare providers, managed care plans, operations teams, and revenue-cycle functions to ensure services are properly documented, authorized, compliant, and ready for reimbursement.
We are looking for a Quality Assurance & Compliance Specialist to review healthcare documentation and help ensure services are compliant, properly authorized, audit-ready, and supported for billing.
This role combines healthcare quality assurance, compliance, revenue-cycle knowledge, and data analysis. You will review records and case notes, identify documentation or compliance gaps, analyze trends, and communicate findings to Operations and Revenue Cycle leadership.
The ideal candidate understands how documentation, authorizations, billing, and payer requirements connect across the healthcare revenue cycle and is comfortable turning detailed findings into actionable reports.
Audit healthcare records, case notes, and supporting documentation for completeness, accuracy, and compliance.
Review authorizations, services delivered, documentation, and claims to confirm they are properly aligned.
Identify compliance gaps, billing risks, documentation deficiencies, and potential financial exposure before claims are submitted.
Analyze recurring errors and trends to help determine where additional training or process improvements are needed.
Review eligibility, payer, authorization, and billing information as part of broader quality-assurance projects.
Create and maintain reports, dashboards, audit logs, and compliance metrics for Operations and Revenue Cycle leadership.
Track findings and corrective actions through resolution and escalate material risks when appropriate.
Support audit readiness and continuous improvement across healthcare operations and revenue-cycle processes.
2–5 years of experience in healthcare quality assurance, medical billing, revenue cycle, authorizations, healthcare compliance, or a related function.
Hands-on experience reviewing medical or healthcare documentation for accuracy, completeness, or billing/compliance requirements.
Strong understanding of how authorizations, documentation, claims, and reimbursement connect within the healthcare revenue cycle.
Strong analytical skills, including the ability to work with raw data, identify trends, and create clear reports or dashboards.
Advanced English with strong written communication and the ability to clearly present findings to U.S.-based stakeholders.
Direct experience with CalAIM, Medi-Cal, Medicaid, or Managed Care Plans.
Previous experience supporting U.S.-based healthcare organizations.
Experience with medical billing, claim denials, revenue integrity, or payer reconciliation.
Experience working for a health insurance company, payer, behavioral health provider, or community health organization.
Familiarity with EHR systems, provider portals, Excel/Google Sheets, or healthcare reporting tools.
Compensation: $1,800–$2,500 USD per month, depending on experience and seniority.
100% remote.
Full-time independent contractor engagement.
Schedule aligned with U.S. Pacific Time, primarily 8:00 AM–5:00 PM PT.
Paid time off and U.S. holiday policy to be confirmed during the hiring process.
Long-term opportunity with exposure to healthcare compliance, revenue cycle, quality assurance, and operational improvement.
If you have experience across healthcare quality, billing, compliance, or revenue cycle and enjoy analyzing documentation and data to identify risks and improve processes, we would love to hear from you.
Apply today to learn more about the opportunity and next steps.