Compliance Auditor

Compliance Auditor

The Compliance Auditor is responsible for ensuring the organization complies with healthcare regulations, internal policies, and industry standards. This role includes performing audits of clinical, operational, and financial practices, identifying compliance risks, and developing and executing corrective actions to maintain regulatory compliance.

Essential Duties and Responsibilities

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities, as necessary.

1. Provides support to the Compliance Department leaders in developing and implementing compliance programs, guiding departments to ensure adherence to policies, and identifying compliance risks and gaps.
2. Conducts and oversees audits across the enterprise to assess compliance with state and federal regulations, policies, and industry standards.
3. Creates audit schedules and plans to ensure comprehensive risk reviews and coverage of all relevant areas.
4. Regularly audits operational and enterprise processes to identify improvement areas, ensuring compliance and recommending changes to enhance efficiency.
5. Performs compliance audits, ensures deliverables are met, maintains detailed audit records, and presents findings and recommendations to management.
6. Manages audit plans and monitors compliance activities, including billing, coding, and healthcare service documentation.
7. Works with departments to ensure policies and procedures are effective and compliant with regulations.
8. Establishes and maintains relationships with audit clients at all levels, ensuring clear communication of audit processes, issues, and project status.
9. Develops and enforces corrective action plans to prevent fraud, abuse, and compliance risks within departments.
10. Creates and presents training on compliance best practices, promoting a culture of compliance within the organization.
11. Additional duties include assists with department initiatives, goals, staff coverage, consultation and special projects as needed.

Qualifications

Education: Bachelor's degree in healthcare administration, nursing, or related field required. Experience may commensurate degree requirements.

Experience

• Minimum 3-5 years of experience in auditing in healthcare compliance, medical billing, and coding preferred.
• Experience in healthcare operations, and/or organizational processes preferred.

Licensure / Certification

• CHC, CHPC preferred and/or required within a minimum of 2 years of employment.

Knowledge, Skills, and Abilities

• General Knowledge of Healthcare Laws and Regulations : Strong understanding of healthcare laws, policies, and regulations, including false claims act, stark law (self-referral law), anti-kickback statute, Centers for Medicare & Medicaid Services regulations.
• Critical Thinking and Analytical Skills : Excellent ability to think critically, analyze data, and pay close attention to detail in identifying compliance issues or discrepancies.
• Effective Communication : Strong verbal and written communication skills to interact with diverse stakeholders, including healthcare providers and administrators.
• Adaptability and Flexibility : Ability to work effectively in a fast-paced environment, respond to multiple requests promptly, and handle competing priorities with a sense of urgency.
• Self-Directed and Organized : Highly organized, able to manage multiple projects simultaneously, and capable of prioritizing tasks independently.
• Professional Integrity and Confidentiality : Dependable with a strong sense of integrity, good judgment, and respect for confidentiality in all aspects of work.
• Proficiency in Computer Skills : Skilled in Microsoft Office programs (Outlook, Teams, PowerPoint, Excel, Word), electronic health records (EHR), and other relevant software applications.
• Training and Facilitation : Ability to develop and deliver employee training, presentations, and facilitate learning.

Typical Working Conditions

• May rotate working in the office and remote/telework
• May involve high and frequent meetings, calls and email volume
• Travel locally up to 30%; may be required to travel nationally up to 10%

Other Physical Requirements

• Vision
• Sense of sound
• Sense of touch

Performance Requirements

High integrity, professional, and able to effectuate change in a fast growing organization to lead the Company's efforts to prevent, detect, monitor, corrects, and educate on compliance related matters. Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.