The Clinical Compliance Auditor executes audits as a part of the company’s compliance audit and controls program. The Clinical Compliance Auditor executes clinically-related (i.e. medical record and related billing) audit procedures to assess compliance-related controls to safeguard company resources, and ensures the effectiveness and efficiency of operations. This position, in conjunction with other Compliance team members, makes recommendations for improvement of controls and processes to ensure risk management, control, and governance systems are functioning as intended and will enable company’s objectives and goals to be met.
RESPONSIBILITIES AND TASKS
- Assists Compliance Audit Manager and Senior Compliance Auditor in planning activities.
- Participates in preparing audit programs based upon the defined objectives.
- Executes/records audit procedures in accordance with Compliance Audit work paper standards.
- Identifies and prioritizes potential exceptions, exposures and opportunities for management review.
- Works with client management and staff to obtain concurrence on issues and recommendations.
- Knows detailed responsibilities required of position.
- Keeps updated and current (regulations, guidance, etc.).
- Understands and utilizes the company resource structure.
- Develops strategies and aligns work to achieve goals.
- Completes special projects and other duties as requested to support needs of organization.
- Networks with co-workers to share best practices.
- Actively participates in the creation/modification of policies and procedures.
- Organizes, plans, and manages time effectively to complete assignments.
- Completes mandatory training and courses required by completion date.
- Reports questionable situations, concerns, complaints or harassment immediately.
- Understands the role of key performance indicators as they relate to areas under audit.
- Develops accurate time budget/ forecast.
- Implements and ensures audit work conforms to professional coding standards.
- Bases audit findings on systematic analyses and effect of decisions on all areas of the company.
- Uses facts/data to completely understand the situation; negotiates mutually-acceptable resolutions.
- Participates in the follow-up process to ensure resolution of audit findings.
- Interprets the relative significance of issues needing resolution; escalates at appropriate time.
- Efficiently plans, manages and audits to minimize resources in audited departments.
- Works with Compliance Audit to develop regulatory audit plan/programs/procedures/standards.
- Formulates audit programs to test current procedures; prepares to document audit tests.
- Audits medical records and billing practices to monitor compliance with applicable regulations.
- Prepares audits, studies, and other findings for the Compliance Audit Department.
- Utilizes resources to effectively and successfully execute responsibilities of the position.
- Completes outpatient billing audit and other audits requiring clinical and/or coding expertise.
License or Certification:
- RN licensure required
- Minimum four years of experience with inpatient and/or outpatient rehab preferred
- Associate’s or Bachelor’s degree in nursing or other clinical degree preferred
- Master’s degree in nursing or other clinical degree desirable
- Knowledge of health care regulations and clinical terminology is required
- Knowledge of governmental reimbursement laws and regulations preferred
- Working knowledge of auditing techniques and auditing standards required
- Strong PC literacy (Microsoft Word and Excel, email)
Enjoy competitive compensation and benefits that start day one of employment, including:
- Affordable medical, dental and vision plans provided to meet the needs of full and part-time employees and their families.
- Generous paid time off that increases with tenure.
- Tuition reimbursement and continuing education opportunities.
- Company-matching 401(k) and employee stock-purchase plans.
- Flexible spending and health savings accounts.
Shift: Day Job
Job ID: 2130385