Performs detailed compliance audits by applying federal and state required audit and review procedures and conducts appropriate compliance audit examinations. Plans, coordinates and conducts healthcare compliance audits in accordance with the approved audit plan, including internal payer audits, compliance audits and vendor audits. Identifies areas of compliance risk and vulnerability by applying current regulatory environment to communications with team members and data gathering. Is a resource on issues related to corporate compliance and appropriate business practices.
ESSENTIAL JOB FUNCTIONS:
1. Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.
2. Completes audit work papers and memorandums by documenting audit findings.
3. Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring.
4. Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings.
5. Assists in the development of Compliance policies and procedures with strong working knowledge of policy development and approval process.
6. Maintains a strong working knowledge of state and federal legislation, statutes and regulations, and local, state, and national health issues affecting DMEPOS organizations.
7. Assists in the investigation and research of compliance issues, such as allegations of HIPAA violations, fraud/waste/abuse, and other compliance issues.
SUPPLEMENTAL JOB FUNCTIONS:
- Performs additional duties as directed.
EDUCATION & EXPERIENCE REQUIRED:
- Bachelor's degree
- 3-7 years of experience professional healthcare audit experience as well as one or more relevant professional certifications (i.e. CHC, CIA, CPA, CFE) is preferred
KNOWLEDGE SKILLS & ABILITIES:
- Strong analytical capabilities
- Little or no traveling required (less than 10%)