Compliance Auditor

Duties and Responsibilities

• Develop and execute an annual Audit Plan that complies with Compliance Program guidance from OIG/DOJ and federal/state regulatory requirements.
• Independently document internal and external audit plans, analyze findings to prepare comprehensive reports, and oversee the implementation of corrective actions. Manage the integrity and retention of all audit materials.
• Store and catalog all audit materials for future review if required.
• Perform additional compliance audits as requested by operational leadership and approved by the Senior Director of Quality Compliance to ensure adherence to all internal policies and procedures and federal/state regulatory requirements.
• Conduct site visits to perform spot audits as needed or directed (up to 10% travel).
• Coordinate responses to payor audits and other audits by external parties.
• Work across multiple internal systems to ensure audit submissions are comprehensive, accurate, and clearly understood.
• Handle requests, physical arrangements, obtaining documents, and compiling information for external audits by payors.
• Remain up to date on all payor and company audit requirements, and remain trained on payor portals, internal systems, dashboards, and all other necessary information systems to ensure the full breadth of a process can be examined.
• Provide weekly, monthly, and quarterly feedback regarding audit activity to the Chief Compliance Officer.
• Cookordination the development, submission, and monitoring of required Corrective Action Plans (CAPs).
• Meet with internal stakeholders to review CAPs, set expectations, and meet submission deadlines.
• Maintain and evaluate the CAP tracker to ensure organizational accountability and timely resolution of risks.
• Conduct an internal audit, post submission, to ensure payor concerns are being addressed as promised.

Qualifications

• Education: Associate degree, Bachelor’s degree preferred
• Work Experience: Knowledge of healthcare compliance program elements, preferred; Knowledge of medical terminology and clinical concepts, preferred

Equipment and Technology Requirements

• Basic computer skills
• Working knowledge of laptop/desktop PC
• Proficiency in Microsoft Suite
• Proficiency in G Suite

Other Competency Requirements

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

Knowledge and Skills

• Excellent communication skills, both written and verbal.
• Data-driven with an aptitude for interpreting results and firm adherence to process.
• Comprehensive understanding of payor requirements and proficiency in navigating CareConnect.
• Track record of success in payor audit responses.
• Knowledge of ABA requirements for nationwide payors.
• Strong understanding of Centria operational processes with the ability to work collaboratively with other departments in collecting documentation.
• Knowledge of computer systems related to compliance, operational, and HR functions.
• Knowledge of audit and compliance process.
• Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks.
• Proven adaptability with a willingness to work both collaboratively and individually to achieve desired business outcomes.
• Excellent interpersonal and listening skills.
• Demonstrated strong work ethic with attention to detail, accuracy, and quality.
• Established track record of generating error-free work.

Working Conditions

• This position utilizes a hybrid work schedule requiring some office hours at the Resource Center. Centria's office hours are Monday through Friday from 8:30 AM – 6:00 PM.
• Additional time or occasional shifts in schedule may be required to complete the above work or meet company objectives.
• 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.

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.