Compliance Auditor - Hospital Services

About the role

The Compliance Auditor will assist in the overall compliance audit and investigative activities to ensure organizational compliance with applicable laws, regulations, and standards of conduct. This person will conduct planned audits, probe audits, chart reviews and contribute to the annual Compliance risk assessment. The Compliance Auditor will also verify reimbursement and/or coding when appropriate. The Compliance Auditor will help complete compliance work plans and provide staff education and internal guidance to operational departments. This person also will investigate compliance and ethical concerns, such as reports of fraud, waste, and abuse.

Responsibilities

• Conduct planned audits, probe audits, chart reviews and contribute to the annual Compliance risk assessment.
• Verify reimbursement and/or coding when appropriate.
• Help complete compliance work plans.
• Provide staff education and internal guidance to operational departments.
• Investigate compliance and ethical concerns, such as reports of fraud, waste, and abuse.

Requirements

• Educational Requirements:
  • Associates Nursing
  • Bachelor Nursing
• Experience Requirements:
  • Minimum Years Required: 5 Years
  • Area of Experience: Clinical
• State of Florida Licensure Requirements:
  • Registered Nurse License
• Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-H) required within one (1) year of hire.
• Compliance certification (CHC) required within two (2) years of hire.

Qualifications

• Strong research skills and knowledge of clinical quality concepts, medical necessity, clinical documentation, and medical terminology.
• Knowledgeable in compliance-oriented tasks including reviewing coverage determinations, Medicare materials, final rules, regulations, and organizational policies, preferred.
• Ability to handle multiple tasks and demonstrate good communication skills preferred.
• Proficient in the use of Microsoft Office programs and ProDiver reporting application preferred.

Skills

• Strong research skills.
• Knowledge of clinical quality concepts.
• Medical necessity.
• Medical documentation.
• Medical terminology.
• Compliance-oriented tasks.
• Reviewing coverage determinations.
• Medicare materials.
• Final rules.
• Organizational policies.

Benefits

• N/A

Pay

• Minimum to Midpoint Pay Rate: $33.37 - $45.05 / hour

Schedule

• Shift 1/8:00:00AM to 4:30:00PM