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The Healthcare Compliance Auditor is responsible for investigating medical service providers and staff to ensure that they meet all legal requirements, review clinical documentation, and identifying potential problems that could create regulatory issues in the future. Since healthcare laws change frequently, this position is responsible for keeping the organization informed about new rules and help them change practices to remain compliant.
Job Responsibilities:
- Investigate and monitor Medical identity theft (physicians and other providers)
- Monitor and investigate Medicare Fraud, Waste, and Abuse - 3rd party vendors, records requests, writing reports and investigating, and report to state and feds.
- Works with Compliance team on annual GRC assessments, staff and patient surveys, PDSAs and other compliance tools
- Monitor SPHER platform to ensure compliance, conduct HIPAA violation investigations
- Audit, create and maintain documentation in support of; CMS mandated audits and OSHA
- Maintain tickler files for safety and facility requirements
- Streamline processes for auditing of patient records
- Prepare, select and audit medical records monthly to ensure accuracy and compliance in our EHR systems.
- Monitor billing and compliance processes
- Develop and implement systems to maintain records for mandatory compliance training, drills, equipment etc. assists and deliver training
- Staying apprised of the DHHS/CMS regulations and guidelines on the Federal level, relative to FQHCs and on the state level relative to D&TCs - Article 28 regulations.
Requirements
Skills / Qualifications:
- High level of attention to detail and critical/analytical thinking
- Must be self-directed and escalate concerns with potential solutions
- Proficiency in Microsoft Office Suite and other healthcare software tools
- Strong written and verbal communication
- Excellent organizational skills and priority setting
- Ability to present to staff and vendors
- Ability to work cooperatively with various departments, and
- Treat confidential information with discretion
Education / Experience:
- Associates Degree in Business or related field, or public/private payor background preferred.
- Licensed Healthcare Auditor (LHA or CPMA) or willing to obtain within the first 12 months of hire
- Minimum of 5 years' experience in healthcare, health insurance, enrollment/claims processing; with proficient knowledge of public as well as private third party payors preferred.
Comprehensive Benefits:
Health / Dental /Vision Insurance
Retirement Plan
Tuition Reimbursement
Public Service Loan Forgiveness
Generous Time Off
