Remote Risk Adjustment Auditor Jobs in North Carolina

Lead enterprise compliance for a fast-growing healthcare organization operating at the center of value-based care, population health, Medicare Advantage, Medicaid, risk adjustment, and home-based clinical operations. This is a senior compliance seat for someone who has worked inside a value-based care enabler or closely comparable model, not a broad hospital-only compliance role.

The right candidate will understand how compliance actually works when clinical teams, nurse practitioners, payer requirements, risk adjustment documentation, multi-state Medicaid obligations, privacy, quality, audits, and executive governance all intersect. You will help build and run a compliance program that supports growth while protecting patients, providers, payers, and the business.

• Lead and strengthen the enterprise compliance program across corporate and clinical compliance.
• Maintain policies, standards, procedures, evidence, reporting, and governance aligned with OIG guidance and applicable federal and state healthcare requirements.
• Conduct compliance risk assessments and help build annual compliance work plans.
• Monitor regulatory changes and translate them into practical operating requirements.
• Lead internal compliance investigations, root-cause analysis, corrective action plans, and follow-through.
• Partner with Clinical Operations, Legal, HR, Information Security, Revenue Cycle, Quality, Credentialing, and Executive Leadership.
• Support compliance with Medicare Advantage, Medicaid, CMS, telehealth, payer, and risk adjustment requirements.
• Monitor clinical and provider compliance, including nurse practitioner scope of practice, collaboration agreements, supervision requirements, licensure, credentialing, privileging, and enrollment.
• Support HIPAA Privacy and Security initiatives in partnership with Information Security.
• Participate in CMS, Medicare Advantage, Medicaid, HIPAA, NCQA, URAC, payer, and related healthcare audits.
• Develop compliance education and training for employees, providers, and leaders.
• Build executive dashboards, compliance metrics, and Board-ready reporting.
• Support M&A, integration, and expansion diligence from a compliance perspective when needed.

• Direct compliance experience in value-based care, population health, risk adjustment, Medicare Advantage, Medicaid, home-based care, or a comparable healthcare enablement environment.
• 7+ years of progressively responsible healthcare compliance experience.
• 3+ years in a compliance leadership role.
• A progressive, explainable compliance career history with increasing scope, stable tenure, and current or recent work in a relevant healthcare environment.
• Experience managing both corporate and clinical compliance programs.
• Strong working knowledge of OIG Compliance Program Guidance, CMS requirements, Medicare Advantage, Medicaid, HIPAA, Fraud, Waste & Abuse, Stark Law, Anti-Kickback Statute, telehealth regulations, provider licensure, credentialing, and nurse practitioner scope-of-practice requirements.
• Experience leading internal investigations, audits, regulatory inquiries, and corrective action plans.
• Ability to translate complex regulatory requirements into practical operating processes.
• Strong executive communication, judgment, documentation, and cross-functional leadership.
• Comfort operating in a growing, multi-state healthcare organization where compliance needs to be both rigorous and practical.

• Experience with organizations similar to value-based care enablement, home assessment, population health, or risk adjustment platforms.
• Experience supporting Medicaid compliance across multiple states.
• Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), JD, MHA, MPH, MBA, or another relevant advanced credential.
• Experience with CMS, NCQA, URAC, Medicaid, Medicare Advantage, HIPAA, payer, or related healthcare audits.
• Experience building compliance dashboards, Board reporting, Power BI reporting, or other executive-level metrics.
• Experience with M&A diligence, integration, or rapid multi-state expansion.
• Experience thinking through appropriate AI usage and safeguards in a regulated healthcare environment.

This is a remote U.S. role with occasional travel as needed for leadership, audit, clinical, or integration work.

The expected compensation range is $140,000 to $160,000 base salary, plus a bonus tied to successful audits and compliance outcomes.

Qualified candidates will complete a video interview with Urrly focused on value-based care compliance depth, Medicare Advantage and Medicaid exposure, clinical/provider compliance, investigations, audit readiness, governance, executive communication, and compensation/logistics alignment. Strong candidates may then be introduced to the client team for additional conversations.

Apply now and get a response within 24 hours.