Quality & Compliance Specialist

Job Description

Job Description

Description:

Quality & Compliance Specialist

Join Axil Health as a Quality & Compliance Specialist and play a vital role in ensuring the integrity and accuracy of our clinical documentation and operational workflows. This position offers an exciting opportunity for detail-oriented professionals to contribute directly to our audit and compliance efforts, supporting our commitment to delivering high-quality healthcare services. If you thrive in a fast-paced, high-accountability environment and are passionate about risk management and process validation, we encourage you to apply.

Key Responsibilities

Audit Validation & Risk Identification

- Review and validate 100% of AI-flagged high-risk encounters prior to billing

- Confirm true compliance risks and discrepancies in clinical documentation

- Track and document identified issues, ensuring clear resolution pathways

- Support audit processes by providing accurate and timely validation of encounters

- Collaborate with operational teams to address and resolve compliance concerns

Audit Reporting:

- Produce structured audit outputs for each audit cycle.

- Document findings clearly

Workflow & Process Compliance Review:

- Review operational workflows

- Identify where workflows may not align with Medicare program requirements

- Flag process-level risks contributing to audit findings

- Surface Issues without owning full workflow design

Issue Escalation & Collaboration:

- Escalate identified issues to appropriate stakeholders

- Collaborate with supervisors and operational teams

Issue Tracking & Resolution Oversight:

- Track all identified audit issues through to resolution

- Follow up on unresolved or recurring issues

- Identify patterns in repeated errors or delays

Continuous Improvement Support:

- Provide practical recommendations to reduce compliance risk

- Support refinement of audit processes and AI tool performance

Compliance Alignment:

- Evaluate documentation and workflows against Medicare program expectations

- Apply learned standards consistently

- Ensure audit findings align with current regulatory expectations and internal policies

- Bachelor’s degree preferred in Healthcare Administration, Business, Compliance, or related field

- 1–5 years of experience in:

• healthcare operations
• quality assurance
• compliance
• auditing
• or other structured, process-driven environments

- Healthcare program experience (CCM, RPM, PCM, APCM) is preferred but not required

Skills and Qualifications

- Proven experience in healthcare compliance, clinical auditing, or related fields

- Strong understanding of Medicare program requirements, including CCM, RPM, PCM, and APCM (Preferred)

- Excellent attention to detail and analytical skills

- Ability to interpret and validate clinical documentation accurately

- Effective communication skills for documenting findings and collaborating with teams

- Proficiency with AI tools and healthcare data management systems is a plus

- High level of integrity, accountability, and problem-solving ability

At Axil Health, we foster a collaborative and innovative culture that values continuous improvement and professional growth. We offer competitive benefits and opportunities to develop your expertise in healthcare compliance and quality assurance. Join us in making a meaningful impact on healthcare delivery through meticulous validation and risk management.