Senior Compliance Auditor - Remote

Overview

Sr. Compliance Auditor

This position is remote

40 hours per week, day shift

Reporting to the Director of Facility Compliance, the Senior Compliance Auditor is tasked with conducting compliance audits and special projects in a professional manner. This role requires a deep understanding of the Medical Center facility or System departments to assess internal controls, financial practices (including charging and billing), policies, procedures, and government compliance. The Senior Compliance Auditor will conduct independent systemic and targeted evaluations of financial data, including billing, charging, and documentation systems (e.g., revenue cycle, electronic medical record, other ancillary systems as necessary for review). 

Must haves: 

Bachelor's degree from an accredited college or university in business, accounting, or related field. 

Three years of related experience in a hospital or health system, with a focus on government reimbursement systems preferred. 

Skills and Qualifications: 

• Skilled in interpersonal relation and able to interface at all levels 
• Ability to work with management 
• Excellent communication, including verbal, written, and listening skills 
• Strong analytical abilities 
• Ability to use computer software including Office products 
• Extensive working knowledge of CMS rules and guidelines 
• Ability to act as a leader, team player and facilitate groups. 

Essential Functions: 

1. Adheres and exemplifies the System's standards of conduct and promotes a cooperative work environment by utilizing communications skills, interpersonal relationships, and team building. 

2. Performs departmental administrative functions including assisting in the general operations of the department. 

3. Assists the Director of Facility Compliance with the execution of the Medical Center and System's annual audit and work plan based on risk assessments conducted with senior administration and other key Medical Center and System leaders. Performs continual assessments of the risks facing the Medical Center and System. 

4. Participates in the daily activities of facility compliance in the completion of the annual audit work plan, which includes audits related mainly to government billing, coding and reimbursement but could overlap into other operational areas. Creates Planning Memos and resulting audit programs to ensure scope is appropriate and objectives are focused. Ensures scheduled and unscheduled reviews are completed timely and the results effectively communicated to affected department management and other interested parties, including senior administration. Monitors the results of the reviews and follow-up reviews to monitor the successful implementation of corrective action plans to address identified issues. 

5. Assists in coordinating audit activity in reviewing Medical Center and System efficiency and effectiveness of operations, protection of assets, compliance with applicable laws and policies, and internal controls. Performs investigations confidentially and competently as requested by management, triggered by Hotline calls or any other circumstances. 

6. Consults, as requested, with the Medical Center and the System operational and revenue cycle administration on internal control aspects of business practices and policy and procedure development, implementation and monitoring. 

7. Maintains knowledge of Center for Medicare and Medicaid Services (CMS) rules and regulations and other current issues related to compliance with those rules and regulations. Analyzes the Medical Center and System's charging and billing practices and internal controls for potential concerns related to compliance with rules, regulations and best practices. Researches issues raised by faculty and staff and coordinates with the Internal Audit, Revenue Cycle, Reimbursement, Legal Affairs, and other System departments to answer the questions related to identified concerns. Maintains a working knowledge of Business Objects and Revenue Cycle systems in order to independently retrieve and analyze data 

8. Assists in the development and delivery of training to educate Medical Center and System faculty and staff regarding CMS and internal compliance policies and procedures. 

9. Reviews Medical Center and System policies related to the internal controls for CMS and internal operational processes. Reviews Medical Center and System polices in conjunction with the Internal Audit Office in an effort to ensure the Medical Center and System is in compliance with rules and regulations governing their activities. 

10. Helps address Medical Center and System issues that are identified through scheduled audits, regulatory changes, or internal / external parties. Researches the relevant laws / regulations and assess the identified concern through the collection and interpretation of data. Develops, in coordination with other Medical Center and System leaders, an action plan to address the issue and monitors the resolution. Such issues could include fraud and/or a misappropriation of assets. Ensures that the issue and its resolution are properly communicated to appropriate parties. 

11. Communicates findings and review results effectively. Assists the Director of Facility Compliance in communicating issues to senior leaders.