Compliance Auditor

Job Description

Job Description

Our Core Values:
The culture at Prism Health North Texas is built on our shared Core Values. We make hiring, firing, promotion and performance review decisions based on these values and behaviors, so it is important that you also share these Core Values:

• We are solution seekers.
• We have a can-do attitude.
• We are mission driven.
• We care about people.

General Description:
The Compliance Auditor serves as a key member of the Legal Affairs and Compliance Department and supports Prism Health North Texas' mission by promoting adherence to applicable federal, state, and grant-related regulatory requirements. This position is responsible for conducting compliance and clinical audits, overseeing patient incident reporting investigations, coordinating peer review activities, supporting audit readiness efforts, and partnering with clinical operations to ensure compliance with standards of care and grant requirements. Responsibilities Specific Responsibilities of the Job:

• Conduct routine clinical, grant, regulatory, privacy, billing, and documentation compliance audits, and report results to compliance and quality committees and other workgroups.
• Assist the Director, Compliance and Privacy in developing and maintaining the annual compliance audit and monitoring work plan.
• Assist the Director, Compliance and Privacy in coordinating and preparing for external audits, reviews, and site visits, including coordinating audit readiness activities and mock audits to assess preparedness for HRSA Operational Site Visits and Ryan White Program monitoring.
• Coordinate provider peer review activities, and support compliance monitoring activities and compliance initiatives as assigned.
• Coordinate and oversee investigations related to patient incidents, complaints, and compliance concerns, ensuring that investigations are completed timely and in accordance with organizational policies and regulatory requirements.
• Analyze compliance, quality, incident and audit data to identify trends, emerging risks and patient safety risks.
• Review, revise and make recommendations for clinical and compliance policies and procedures to ensure alignment with regulatory requirements, standards of care, and organizational practices.
• Maintain a working knowledge of applicable federal, state, local, and grant-related regulatory requirements, including but not limited to Health Resources and Services Administration (HRSA) regulations and requirements, Federally Qualified Health Center (FQHC) program requirements, Ryan White HIV/AIDS Program requirements, 340B Drug Pricing Program compliance requirements, HIPAA Privacy, Security, and Breach Notification Rules, Medicare and Medicaid program requirements, Fraud, waste, and abuse laws and regulations, Office of Inspector General (OIG) compliance guidance, Applicable Texas healthcare regulations and reporting requirements, Clinical documentation, quality, and patient safety standards.

Required Skills Required Knowledge, Skills, and Abilities:

• Knowledge of healthcare compliance principles, auditing methodologies, and regulatory requirements.
• Ability to interpret and apply federal, state, and grant-related regulations.
• Strong investigative, critical thinking, and problem-solving skills.
• Ability to prepare clear and concise audit reports and recommendations.
• Excellent verbal and written communication skills.
• Ability to establish effective working relationships across all levels of the organization.
• Proficiency in electronic health records, Microsoft Office applications, and data analysis tools.
• Ability to manage multiple projects and deadlines while maintaining confidentiality and professionalism.

Required Education and Experience:

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, Health Information Management, Business Administration, Compliance, or a related field.
• Minimum of three (3) years of healthcare compliance, auditing, quality, risk management, clinical auditing, or related experience.
• Experience conducting audits, investigations, compliance monitoring, or regulatory reviews in a healthcare setting.
• Strong analytical, organizational, and report-writing skills.
• Clinical experience in a healthcare setting strongly preferred.
• Experience in a Federally Qualified Health Center (FQHC), community health center, public health organization, hospital, or healthcare system preferred.
• Relevant professional certification such as Certified in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional (CCEP), Certified in Healthcare Privacy Compliance (CHPC) a plus.