Compliance Auditor - Nurse

Key Responsibilities

• Demonstrates good analytical and organizational skills and the ability to collect, analyze and utilize data.
• Possesses good people skills for effective liaison with department, company and agencies while maintaining objectivity, accuracy, and confidentiality.
• Demonstrates knowledge of state and federal laws and regulations that apply to Home Health, Hospice and HCC operations and billing requirements. In addition to state policies related to community services.
• Demonstrates knowledge of organizational processes, policies, procedures, and systems related to compliance audits and investigations.
• Demonstrates knowledge and ability to manage the Medicare and Medicaid denials and appeals process.
• Demonstrates ability to perform and document audits, including interview, observations, and record reviews timely.
• Demonstrates ability to work well both independently and with others.
• Demonstrates ability to assist with preparation of documents in response to external audits.
• Maintains appropriate degree of confidentiality of company information.
• Demonstrates the ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, governmental regulations, and legal documents.
• Participates and contributes to team projects.
• Performs other duties as assigned by the supervisor.

Knowledge, Skills, Abilities

• Self-motivated, purposeful, and flexible to frequently shifting work priorities.
• Experience working in a licensed and/or federally certified long-term care or health care program or regulatory agency.
• Excellent communication and organizational skills.
• Ability to work unsupervised and to prioritize and manage multiple assignments with integrity.
• Experience working with computers and varied computer programs (Microsoft Word, Excel, TEAMS, Power Point).
• Excellent written and oral communication and organizational skills.
• Ability to perform internal compliance investigations and audits including compiling detailed reports with recommendations.
• Ability to develop or extract measurable standards from qualitative criteria.
• Ability to manage a demanding and diverse workload.
• Ability to participate in policy development.
• Ability to participate in training efforts with other partners.

Licensure, Certification And Education Requirements

• Must be a Registered Nurse in good standing in at least one of the states in which PruittHealth operates.
• Active professional license is required and are to be renewed as appropriate following state regulations.
• Knowledge of state and federal regulations for SNF, Home Health and/or Hospice preferred.
• Free from illegal use of drugs and alcohol in the workplace.
• Persons who have been found guilty by a court of law of abusing, neglecting or mistreating individuals in a healthcare related setting or, who have been excluded from the Medicare and/or Medicaid program, are ineligible for employment in this position.