Compliance and Audit Specialist

About the Role

At Curai, we believe that access to high-quality healthcare is a fundamental human right, not a privilege. Our mission is to radically transform healthcare delivery by harnessing the power of artificial intelligence and clinical expertise to make care more affordable, accessible, and effective for everyone. Patients interact with advanced AI systems at every step of their care and follow-up. Licensed physicians review each case with the patient for the clinical decision in our integrated virtual clinic. We ground our approach in rigorous research, continuous learning, and a deep commitment to clinical integrity. We focus on making a real impact: improving health outcomes, expanding access to care, and setting new standards for what trustworthy, patient-centered healthcare is. The Healthcare Compliance Analyst serves as a key individual contributor responsible for supporting and advancing the organization's compliance program. This role monitors adherence to federal, state, and local healthcare regulations, identifies areas of risk, conducts audits and investigations, and provides education to staff on compliance-related matters. The Compliance Analyst works collaboratively with clinical, operational, legal, product, and other teams to foster a culture of ethical conduct and regulatory compliance while ensuring the organization meets all applicable requirements, including those related to billing, coding, privacy, and patient safety.

Responsibilities

• Monitor and interpret changes in healthcare laws, regulations, and guidance from agencies such as CMS, OIG, OCR, and state health departments, assessing the impact on virtual care operations.
• Conduct periodic risk assessments to identify compliance vulnerabilities and recommend corrective actions.
• Maintain current knowledge of fraud and abuse laws, including the Anti-Kickback Statute, Stark Law, and the False Claims Act, and advise operational teams on their implications.
• Plan and conduct internal compliance audits of clinical documentation, billing and coding practices, referral arrangements, and operational workflows in outpatient and clinic settings.
• Develop audit tools, work plans, and sampling methodologies appropriate to ambulatory care environments.
• Analyze audit findings, prepare detailed reports with root-cause analyses, and track corrective action plans through resolution.
• Monitor key compliance metrics and prepare periodic reports for compliance leadership.
• Receive, triage, and investigate compliance concerns, hotline reports, and potential violations.
• Document investigation findings, maintain investigation files, and recommend appropriate remediation.
• Assist with voluntary self-disclosures and refund processes when overpayments or compliance issues are identified.
• Draft, review, and update compliance policies, procedures, and standard operating procedures to reflect current regulatory requirements and industry best practices.
• Assist in the development of compliance program documentation, including the annual work plan and compliance committee materials.
• Develop and deliver compliance training content tailored to outpatient and clinic staff, including topics such as HIPAA/privacy, fraud and abuse, proper documentation, and code of conduct expectations.
• Provide targeted education in response to audit findings, regulatory changes, or emerging risk areas.
• Serve as a day-to-day compliance resource for managers, providers, and staff.
• Partner with revenue cycle, health information management, clinical operations, and human resources teams on compliance-related matters.
• Participate in compliance committee meetings and prepare supporting materials.
• Maintain effective working relationships with external regulatory bodies as needed.

Requirements

• Bachelor's degree in Healthcare Administration, Health Information Management, Nursing, Business Administration, Public Health, or a related field. A combination of equivalent education and experience may be considered.
• Minimum of 3–5 years of progressive experience in healthcare compliance, regulatory affairs, coding/billing auditing, or a closely related function.
• Demonstrated experience conducting compliance audits and investigations in a healthcare environment.
• Working knowledge of Medicare and Medicaid billing regulations, CPT/ICD-10 coding, and payer requirements applicable to outpatient services.
• One or more of the following certifications (or must be obtained within 12 months of hire): Certified in Healthcare Compliance (CHC) – Health Care Compliance Association (HCCA), Certified in Healthcare Privacy Compliance (CHPC) – HCCA, Certified Professional Compliance Officer (CPCO) – AAPC
• Strong understanding of healthcare regulatory frameworks, including federal and state fraud and abuse laws, HIPAA, EMTALA, and CMS Conditions of Participation/Coverage.
• Excellent analytical and critical-thinking skills with the ability to interpret complex regulations and translate them into actionable guidance.
• Strong written and verbal communication skills, including the ability to present findings and recommendations to diverse audiences.
• High degree of integrity, professionalism, and discretion when handling sensitive and confidential information.
• Ability to manage multiple projects and priorities with minimal supervision.
• Proficiency in Microsoft Office Suite; experience with compliance management software or data analytics tools is a plus.

Qualifications

• Master's degree in a related field.
• Experience with compliance program operations within a multi-site clinic or health system environment.
• Familiarity with EHR systems (e.g., Epic, Athenahealth, eClinicalWorks) and billing platforms.
• Experience with OIG compliance program guidance for individual and small group physician practices.
• Knowledge of state-specific healthcare regulations and licensure requirements.
• Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) credentials are a plus