Auditor, Compliance Job Description
Auditor, Compliance Duties & Responsibilities
To write an effective auditor, compliance job description, begin by listing detailed duties, responsibilities and expectations. We have included auditor, compliance job description templates that you can modify and use.
Sample responsibilities for this position include:
Auditor, Compliance Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Auditor, Compliance
List any licenses or certifications required by the position: ASQ, CHC, AHIMA, CHPC, HCCA, ISO, CIA, CRCM, CISA, ITIL
Education for Auditor, Compliance
Typically a job would require a certain level of education.
Employers hiring for the auditor, compliance job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Accounting, Finance, Education, Business, Auditing, Healthcare, Business/Administration, Real Estate, Engineering, Management
Skills for Auditor, Compliance
Desired skills for auditor, compliance include:
Desired experience for auditor, compliance includes:
Auditor, Compliance Examples
Auditor, Compliance Job Description
- Performs compliance testing to ensure business line controls are designed sufficiently and operating effectively
- Provide recommendations for improvement to management in the areas of Cost Accounting, Internal Control and Government Compliance
- Partner closely with peers in Accounting and Finance to define risk areas that may require further review and/or audit
- May provide guidance to hospital entities and performs reviews as needed in response to external medical necessity audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC
- Participate in discrepancy investigations
- Assist staff interpreting and implementing regulatory requirements
- Conduct routine internal audits of provider agreement documentation on a timely basis
- Review internal controls, policies, and procedures to ensure compliance with appropriate DUHS guidelines and policies, and federal and state regulations
- Respond promptly to external and internal concerns
- Promote Compliance initiatives with clinical faculty, staff and administration
- Audits outpatient coding and billing records to ensure billing and documentation accuracy
- Assist Compliance Director with Legal investigations
- Conducts investigations of potential fraudulent or abusive activities as directed by Director of Compliance
- Perform annual chart audits and formulate recommendations based upon the audit findings and communicate them to the appropriate personnel
- Implement annual coding reviews, create work plans based on the reviews and ensure that compliance issues and areas of risk are identified and addressed
- Assist in curriculum development to be used in orienting and educating physicians and staff to medical record documentation guidelines and standards and to diagnostic and procedural coding conventions and methodologies
Auditor, Compliance Job Description
- Assist in the preparation of complex cost modeling files (Excel) in support of required Government reporting
- Follow audit programs and conduct internal audits under a risk-based methodology
- Extract and analyze data to determine if deficiencies or non-compliances with Government regulations or internal procedures exist
- Gain a working knowledge of Government Regulation, specifically the Federal Acquisition Regulation (FAR)
- Work with external consultants and Legal Counsel on various compliance related projects
- Assists in the development of audit programs that clearly and accurately indicate method to achieve all desired objectives
- Update and execute the company-wide export and import audit program
- Reviewing responses to audit findings for completeness and effectiveness
- Participating in PH Quality & Regulatory initiatives as a cross functional contributor
- Providing audit coaching/readiness training, and support for external audits
- Coding compliance resource and consultant for all physician and mid-level providers, company administrators, and physician practice staff
- Assist in developing policies and procedures on coding compliance for clinics and the compliance department
- Maintains accurate project documentation, including detailed project planning and tracking process
- Provides Compliance Director, Coding and Billing with regular updates, status reports, and progress variances
- Develop and present educational training materials for hospital and clinic medical staff, coders, billers, and case management staff
- Interprets clinical information in the medical record, evaluate medications, vital signs, surgical outcomes
Auditor, Compliance Job Description
- Conduct interviews and walk-throughs, performing analysis to identify key business risks and controls
- Prepare formal written reports of findings and recommendations for Dealership and CCAO management that will identify and monitor business opportunities for improvement
- Remain current and increase knowledge in the areas of auditing, business and industry trends
- Monitor and generate regular reports on insurance company financial ratings for compliance with company guidelines and reports adverse findings as necessary
- Assist Department Managers with special projects as needed
- Perform Title 31 Audit
- Ensure new Receipting Compliance employees are oriented to the organization, its policies, facilities
- Develop training plan for Receipting Compliance employees to ensure they have the necessary expertise to carry out their job, provide ongoing guidance, often in the form of ongoing coaching and counseling
- Perform or directs transactional testing performed by account review specialists as necessary
- Actively contribute to a wide array of security projects
- Promptly reports any and all potential compliance issues to the Director of Compliance
- Comply with all Baylor Scott and White compliance policies and procedures
- Maintains confidentiality of work plans and projects
- Understands and maintain strict professional confidentiality
- Participates in seminars, inservice/educational programs, and other activities sponsored by professional associations at the local state, and national levels
- Fulfill continuing education requirements to maintain credential/license status
Auditor, Compliance Job Description
- Establish/maintains professional working relationships with point of contacts of QA contractor, service delivery contractors, MACS-OCC client staff, and internal customer base
- Facilitates effective communication both verbally and in-writing to ensure customer service and quality assurance efforts meet the demands of the contract and the client
- Investigates customer complaints and provides necessary feedback and follow-up for successful and timely resolution
- Provides findings and resolution information to operations management for follow-up and possible reward and/or corrective action
- Works in close partnership with QA contractor to identify and monitor complaint trends
- Reviews and assesses two-way radio communication between operators and dispatchers to ensure professional interaction and cooperation between MV staff and service delivery employees
- Attends various public events as a representative of the program to provide information and feedback to general concerns/items of discussion
- Provide resource information as necessary for interested parties regarding the transportation system as a whole, and referrals to appropriate agencies for transportation assistance
- Plan, design, and execute the audit coverage strategy for the Internal Audit compliance program
- Work with the key compliance stakeholders to identify emerging issues and systemic control issues – update the audit strategy and program appropriately and timely
- Must have extensive knowledge in CPT and ICD-10-CM coding classification
- Candidate must have regulatory audit experience (energy industry preferred but not required)
- Will be responsible for making sure that all functions of the audit including Gap Analysis, Mock Audits, and the Live Audit meet regulatory standards
- Candidate must be self-driven/motivated in order to drive audit processes/projects in a highly fast paced and stressful environment
- Some travel may be required for Live Audit completions
- Contract only position
Auditor, Compliance Job Description
- Demonstrates skills in identifying and assessing process risks, flowcharting business processes including the supporting applications, identifying and evaluating the design and operational effectiveness of controls, executing and documenting audit tests
- Analyzes business process and internal control documentation and develop written summary of audit findings to review with Audit Management
- Supports the organization's mission/compliance program through participation in meetings, task forces, committees, and special projects
- Develops and maintains specialized expertise within the job function
- Contributes to the compliance annual workplan
- Investigates issues as assigned and makes recommendations for resolution
- To conduct any CRS Audit scheduled by CRS Admin coordinator
- To submit audit report base on established report turnaround time
- Responsible for the Quality of Audit Report submitted to report reviewer
- To Study and Understand Audit requirements as established by clients
- Experience with and knowledge of instructional notations and conventions of ICD-9-CM, ICD-10, CPT, HCPCS, APC classification systems
- An ability to think critically, prioritize efforts using a risk-based approach, and drive positive change
- Knowledge of Microsoft Office software (Word, Excel, Powerpoint)
- Solid understanding of banking, BSA/AML and mortgage industry regulatory requirements (FDIC, CFPB)
- This position is located in Plymouth, MN and may require some travel.Quality Assurance
- Exposure to continuous improvement projects GMP, WCM, Six Sigma etc