Healthcare Delivery Auditor

About the role

The Healthcare Delivery Auditor supports Central Health’s mission to provide access to high-quality care for underserved populations by conducting internal audits of healthcare delivery programs and clinical services.

Responsibilities

• Conducts risk-based audits of healthcare delivery and clinical operations, including patient chart reviews, referral processes, and encounter documentation.
• Conducts detailed audits including data collection, analysis, and testing of internal controls.
• Affirms compliance with federal and state healthcare regulations, Central Health policies, and contractual obligations with delivery system partners.
• Evaluates the effectiveness and efficiency of operations and compliance with applicable laws and regulations.
• Documents audit findings, prepares workpapers, and ensures proper evidence is maintained.
• Drafts clear and concise audit reports summarizing findings, conclusions, and recommendations.
• Maintains awareness of changes in laws, regulations, and industry standards.
• Performs risk assessments to identify areas of potential vulnerability and risk.
• Aids in the development and implementation of risk management strategies.
• Recommends improvements to policies, procedures, and systems to enhance internal controls.
• Remains up to date on best practices in audit and internal controls.
• Preforms other duties as assigned.

Requirements

• Extensive understanding of healthcare laws, regulations, and standards such as HIPAA, OSHA, The Joint Commission (TJC), and local/state regulations.
• Working knowledge of healthcare regulations (e.g., CMS, Medicaid, HIPAA), documentation standards, and billing requirements.
• Knowledge of patient safety standards and quality improvement protocols.
• Familiarity with the principles of risk management, including risk identification, assessment, mitigation, and monitoring.
• Understanding of risk management frameworks and methodologies, such as Failure Mode and Effects Analysis (FMEA) and Root Cause Analysis (RCA).
• In-depth knowledge of clinical workflows and healthcare operations, including patient care processes, medical documentation, and healthcare technologies.
• Awareness of potential risks inherent in clinical practices, such as medication errors, infection control breaches, and patient safety issues.
• Understanding of crisis management strategies and emergency preparedness planning.
• Knowledge of disaster recovery and business continuity planning in a healthcare context.
• Knowledge of data analytics and reporting techniques relevant to risk management.
• Proficiency in conducting root cause analyses, developing risk assessments, and recommending corrective actions.
• Strong analytical, organizational, and communication skills, with the ability to interpret clinical data and regulatory criteria.
• Ability to communicate findings, reports, and recommendations clearly and persuasively.
• Ability to lead risk management initiatives and work collaboratively with interdisciplinary teams.
• Skills in project management, prioritizing tasks, managing time effectively, and meeting deadlines.
• Ability to identify problems, generate solutions, and implement effective strategies to mitigate risks.
• Ability to adapt to changing regulations, technologies, and healthcare practices.
• Strong ethical judgment and the ability to maintain objectivity and integrity when dealing with sensitive issues and conflicts of interest.

Qualifications

• Bachelor's Degree (higher degree accepted) in Healthcare Administration, Public Health, Nursing, Business, or a related field.
• 3 years Experience in healthcare auditing, chart review, or compliance in a clinical or managed care setting.

Skills

• Analytical and Critical Thinking.
• Data Analytics and Reporting.
• Communication.
• Leadership and Collaboration.
• Problem-Solving.
• Decision-Making.
• Attention to Detail.
• Adaptability and Flexibility.
• Interpersonal Skills.

Benefits

Central Health offers a comprehensive benefits package including health insurance, dental insurance, vision insurance, retirement plans, paid time off, and more.

Pay

$X per hour or $Y per year, depending on experience and qualifications.

Schedule

Full-time position with standard business hours.