Compliance Auditor
The Compliance Auditor will foster an environment that enhances and promotes compliance and adherence to all relevant federal, state, and local laws, rules and regulations applicable PACE, Part D, LHCSA and Article 28 requirements, etc., through audits. The Compliance Auditor is responsible for performing internal and external auditing functions for the Compliance Department of C2Q Health Solutions.
The Compliance Auditor applies advanced regulatory knowledge and analytical judgment to proactively conduct effective risk assessments and assist in preparing annual audit plan.
Key responsibilities include:
- Assist in conducting enterprise-wide risk assessments and actively contribute to the development and execution of the annual compliance audit plan.
- Design and implement comprehensive, risk-based audit programs to assess compliance with governmental, contractual, and regulatory requirements.
- Perform independent audits and monitoring activities in accordance with the approved audit plan, ensuring appropriate scope, testing, and documentation.
- Identify root causes, and systemic compliance risks; clearly document observations and support findings with defensible evidence.
- Communicate audit results effectively, using data and analysis to support conclusions and recommendations.
- Partner with operational leaders to develop, track, and validate corrective action plans, ensuring timely and sustainable remediation.
- Monitor audit outcomes and trends, reporting progress and residual risk to compliance leadership and governance as appropriate.
- Maintain high-level knowledge of applicable laws, regulations, and guidance, and provide targeted education and advisory support to management and stakeholders.
- Serve as a compliance resource by being accessible, collaborative, and solution-oriented.
- Perform additional duties as assigned in alignment with the goals, and responsibilities of the Compliance Department.
Schedule: 8:30AM – 5:30PM
Weekly Hours: 40
Qualifications:
Education: Bachelor's degree in health care administration, political science, social science or related field required.
Experience:
- Minimum of three (3) years Healthcare Audit background preferably in a Health Insurance Plan
- Understanding of Medicare and Medicaid programs is strongly preferred.
- An in-depth understanding of the industry's rules, guidelines, and regulations.
- Billing and Coding experience, preferred.
- Strong attention to detail, analytical, and statistical skills.
Physical Requirements
Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:
- Standing - duration of up to 8 hours per day in the field/community
- Sitting/Stationary positions – sedentary for 6-8 hours a day for consecutive hours/periods.
- Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc.
- Bending/Squatting – have to be able to safely bend or squat to perform the essential functions under the scope of the job.
- Stairs/Steps/Walking/Climbing – must be able to maneuver stairs safely, climb up/down and walk to access work areas. The position requires an individual to be able to travel and walk between sites/locations and work areas throughout the day.
- Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.)
- Sight/Visual Requirements – must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc.
- Audio Hearing and Motor Skills (language) Requirements – must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual.
- Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.
Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.
We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.