Compliance Auditor

Compliance AuditorThe Compliance Auditor is responsible for conducting compliance auditing, monitoring, and risk assessment activities to ensure organizational adherence to federal, state, accreditation, contractual, and organizational requirements. This position evaluates clinical, billing, operational, and administrative functions to ensure compliance with regulations and standards established by the Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Managed Care Organizations (MCOs), and other applicable regulatory authorities.The Compliance Auditor identifies areas of regulatory risk, recommends corrective actions, evaluates the effectiveness of compliance controls, and supports continuous improvement efforts throughout the organization.Essential Duties and ResponsibilitiesCompliance Auditing and MonitoringConduct routine and focused audits of clinical documentation, medical records, billing, coding, claims submission, service authorization, and operational processes.Perform audits to ensure compliance with CMS, Medicaid, TennCare, TDMHSAS, TJC, OIG, and MCO requirements.Evaluate documentation for medical necessity, treatment planning, service delivery, timeliness, and completeness.Review provider credentialing and licensure compliance.Assess adherence to organizational policies and procedures.Develop audit work plans, audit tools, and monitoring methodologies.Maintain audit schedules and ensure completion of annual compliance audit plans.Risk Assessment and AnalysisIdentify regulatory, operational, financial, and compliance risks across the organization.Analyze audit findings to identify trends, root causes, and systemic issues.Assist with annual compliance risk assessments.Evaluate internal controls and compliance processes for effectiveness.Recommend risk mitigation strategies and process improvements.Corrective Action and Follow-UpPrepare written audit reports detailing findings, observations, risks, and recommendations.Collaborate with department leaders to develop corrective action plans.Monitor implementation of corrective actions and validate effectiveness.Conduct follow-up audits to ensure sustained compliance.Track audit findings and compliance metrics.Regulatory and Contractual ComplianceMonitor changes in federal and state healthcare regulations affecting behavioral health services.Ensure compliance with:OIG Compliance Program GuidanceCMS Medicaid and Medicare regulationsTJC accreditation standardsTDMHSAS licensing and contractual requirementsTennCare regulationsManaged Care Organization (MCO) contracts and policiesHIPAA Privacy and Security RulesFraud, Waste, and Abuse regulationsSurvey and Audit ReadinessAssist departments in preparing for regulatory reviews, accreditation surveys, external audits, and site visits.Participate in mock surveys and readiness assessments.Review evidence and documentation requested by surveyors and auditors.Support remediation activities resulting from external audits.Reporting and DocumentationMaintain complete and accurate audit documentation and work papers.Prepare reports for the Compliance Committee, Executive Leadership Team, and Board of Directors.Track key audit indicators and organizational compliance trends.Utilize compliance management software, spreadsheets, and reporting tools to monitor audit outcomes.Education and ConsultationProvide guidance to operational and clinical staff regarding compliance requirements.Educate departments on audit findings and regulatory expectations.Assist with compliance training and awareness initiatives.Serve as a compliance resource for managers and leadership.Required QualificationsEducationBachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Social Work, Behavioral Health, Accounting, or related field required.Master's degree preferred.ExperienceMinimum of three (3) years of healthcare auditing, compliance, quality improvement, revenue cycle, or regulatory experience required.Experience in behavioral health, community mental health, substance use treatment, or healthcare settings strongly preferred.Experience auditing Medicaid-funded services preferred.Preferred CertificationsCertified in Healthcare Compliance (CHC)Certified Professional Medical Auditor (CPMA)Certified Internal Auditor (CIA)Certified Professional Coder (CPC)Certified Healthcare Internal Audit Professional (CHIAP)Knowledge, Skills, and AbilitiesRegulatory KnowledgeExtensive knowledge of:OIG Compliance Program GuidanceCMS regulationsMedicaid and TennCare requirementsTJC accreditation standardsTDMHSAS rules and regulationsMCO contractual requirementsHIPAA Privacy and Security RulesFraud, Waste, and Abuse prevention practicesTechnical SkillsMedical record review and auditingData analysis and trend identificationAudit report writingRisk assessment methodologiesRoot cause analysisCorrective action plan developmentProficiency with EHR systems and Microsoft Office applicationsProfessional SkillsStrong analytical and critical thinking abilitiesExcellent verbal and written communication skillsHigh attention to detailAbility to maintain confidentialityStrong organizational and time-management skillsAbility to work independently and collaborativelyWork EnvironmentPrimarily office environment.Ability to travel between organizational sites as needed.Ability to sit for extended periods while reviewing records and data.Ability to access and review electronic health records and paper documentation.Will require participation in regulatory surveys, audits, accreditation reviews, and compliance investigations.Must maintain confidentiality and handle sensitive information appropriately.Mental Health Cooperative offers a full comprehensive benefit plan for you to participate in. The following products are available:Medical Insurance/Prescription Drug CoverageHealth Savings AccountDental & Vision InsuranceBasic Life and AD&D InsuranceShort- & Long-Term DisabilitySupplemental Life InsuranceCancer InsuranceAccident & Critical Illness Insurance403b - Retirement PlanCalm App for medication and mental healthGym membership discountsPet InsurancePaid Time OffMental Health Cooperative embraces inclusion, diversity, and equal opportunity. We're committed to building a team that represents a variety of backgrounds, perspectives, and skills. Mental Health Cooperative is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.