Healthcare Compliance Auditor (US Auditing)

OVERVIEW/GENERAL PURPOSE OF POSITION

The Compliance Auditor is responsible for planning and executing internal audits, and provides support to external audits. This position will evaluate operating and regulatory guidelines, policies and procedures, and reports negative results to management. As needed, the Auditor will utilize various databases, and spreadsheets to manage the audit process.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Assist Compliance Manager in accessing Medicare program guidelines.

Evaluate process, policy, to ensure compliance with regulatory guidelines.

Act as an internal resource and subject matter expert on Medicare guidelines, providing regulatory guidance and interpretation to business owners to ensure ongoing compliance and consistency.

Perform internal compliance audits on operational departments to ensure compliance with business practices and regulatory guidelines.

Monitor calls for compliance

Develop internal reports, action or corrective action plans

Prepare and participate in internal/external compliance audits.

Participate in regular meetings with business owners.

Review reports or other documents to identify issues and trends.

Participate in the development of any applicable compliance training, education or communication

Review training, education and communications developed by other departments from compliance prospective.

Maintain a working knowledge of relevant issues, laws and regulations.

Participate in ongoing education and training.

Perform regulatory research related to company operations

Communicate with coworkers, management, staff, customers, and others in a courteous and professional manner.

Conform with and abide by all regulations, policies, work procedures and instructions.

EDUCATION AND EXPERIENCE

Bachelor's degree preferred from an accredited college or university

Minimum of one (1) year experience in health care (Medicare Programs), insurance, compliance, regulatory or law, with experience in legal research of regulatory issues and performing audits to measure compliance with regulations or any equivalent combination of related training and experience. Experience in billing and enrollment also desired.

OTHER DUTIES AND RESPONSIBILITIES

Responsible for compliance with all federal, state and local laws, rules and regulations affecting Company.

Responsible for participating in quality assurance, compliance and in-service and continuing education activities as requested by Company.

Responsible for performing other duties and responsibilities as required.

Act, dress, and behave in a professional manner to reflect a positive image of the company.