Clinical Compliance and Operations Auditor

Position Summary

The Clinical Compliance and Operations Auditor is responsible for conducting rigorous onsite evaluations to ensure centers maintain the highest standards of operational and clinical integrity. This role involves performing "surprise" audits to observe real-time operations, conducting facility walk-throughs, and auditing client records. The Auditor serves as a critical frontline evaluator, preparing local staff for external reviews from payors and accreditation bodies while providing data-driven feedback to leadership.

Duties and Responsibilities

• Conduct unannounced onsite reviews of centers within an assigned territory to observe live operations.
• Implement comprehensive center walk-throughs to ensure compliance with physical site and safety standards.
• Interview clinical and operational staff to assess knowledge and adherence to company and regulatory protocols.
• Review client records and clinical documentation to ensure compliance with payor and regulatory practices.
• Prepare center staff to respond effectively to external evaluators, including payors and accreditation bodies (e.g., JCAHO, BHCOE).
• Compile and generate detailed audit reports following each visit, summarizing findings for internal stakeholders.
• Log audit details and progress in a trackable, real-time format.
• Provide data-in-practice to inform leadership on time overhead for travel, report writing, and debriefing.
• Monitor adherence to clinical quality elements of payor Corrective Action Plans.
• Generate detailed, quantitative audit reports, ensuring finding classifications and raw data support executive-level trend analysis and risk forecasting.

Qualifications

• Education: Master’s degree required. Doctorate preferred.
• BCBA certification. BCBA-D preferred.
• Work Experience: Minimum of 10 years of experience as a BCBA or higher. Minimum of 3 years of experience in a senior leadership role overseeing clinical compliance for a large-scale, multi-state healthcare organization. Proven track record navigating Medicaid, OIG, and private payor clinical audits. Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations. Proven record of success in a highly detail-oriented, evaluative environment, experience in compliance or operational auditing preferred.
• Knowledge: Knowledge of ABA clinical and documentation best practices and terminology. Experience with clinical review or payor clinical review responses.

Equipment and Technology Requirements

• Working knowledge of laptop/desktop PC.
• Proficiency in Microsoft Suite (Word, Excel).
• Proficiency in G Suite (Gmail, Drive, Docs, Sheets, Google Meet).

Other Competency Requirements

• Ability to follow written instructions.
• Ability to use computers and computer/software programs.
• Ability to communicate expressively and receptively.

Rates

$95,000 - $110,000 per year plus bonus.

Benefits

No benefits listed.

Working Conditions

• Centria's office hours are Monday through Friday from 8:30 AM – 6:00 PM.
• Additional time or occasional shift in schedule may be required to complete the above work or meet company objectives.
• Weekly travel (Monday thru Thursday) to regional centers and the Resource Center for site audits and leadership summits will be required.
• Physical Demands: While performing the duties of this job, physical requirements such as bending, reaching, lifting, pushing, or pulling up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing periodically. This role may require close visual acuity on computer screens or monitors and the ability to analyze data and figures on a screen.

Equal Opportunity Employer

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status.