Compliance Auditor

Job Description

Job Description

Position: Compliance AuditorLocation: Hybrid (Must Reside in NY/NJ/CT)Work Schedule: Monday - Friday, 9:00am - 5:00pmCompensation: $77,506.87 - $87,195.23 Annual Salary Our OrganizationVillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.Our mission is to promote healing, better health and well-being to the fullest extent possible. Our care is offered through a comprehensive array of community and residential programs, as well as managed care. VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.Role Summary: Under the supervision of the Director of Compliance & Internal Audit, the Compliance Auditor will lead and execute audits to ensure adherence to federal, state and local laws, rules and regulations for Medicare and Medicaid. The position audits the plan's operational areas, providers, and First Tier, Downstream or Related Entities. The position reports audit results and recommendations to stakeholders and senior leadership as well as ensures performance of root cause analysis and implementation of corrective action plans. Key ResponsibilitiesPlan, develop, and conduct compliance audits of providers as well as internal departments of the health plan such as claims, enrollment, care management, utilization management, credentialing, sales, etc.Document audit planning activities including the objective, scope, relevant risks, and testing procedures.Perform sample testing to verify the effectiveness of processes, compliance with applicable regulations, and adherence to internal policies and procedures.Prepare clear, organized, and complete audit workpapers to support sample testing results.Use professional judgment to make evidence-based, objective decisions to identify issues and recommend risk mitigation and process improvement.Create audit reports to communicate results to internal and external stakeholders, including leadership.Monitor the development and implementation of corrective action plans by audit participants.Communicate audit progress to audit participants and the Director of Compliance and Internal Audit in a timely manner.As part of compliance audit activities, identify potential FWA and additional risks associated with processes under review.Support external audits conducted by CMS, OIG, DOH, OMIG, and other regulators by performing mock audits and audit readiness exercises.Required qualifications:- Bachelor's degree- Minimum 2 years of related experience- Knowledge of CMS and NY DOH Medicare/Medicaid regulations; familiarity with claims and care management processes- Strong analytical, communication, and project management skills; proficiency in MS Office- Willingness to pursue CIA and CHC certificationsIf you're ready to build a career in healthcare compliance and audit, apply today.

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