Clinical Compliance and Operations Auditor

Centria Autism•Dearborn, MI

12d•Onsite

About The Position

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.

Requirements

Master’s degree required
BCBA certification
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 of ABA clinical and documentation best practices and terminology.
Experience with clinical review or payor clinical review responses.
Working knowledge of laptop/desktop PC
Proficiency in Microsoft Suite (Word, Excel)
Proficiency in G Suite (Gmail, Drive, Docs, Sheets, Google Meet)
Ability to follow written instructions
Ability to use computers and computer/software programs
Ability to communicate expressively and receptively
Proven ability to design, implement, and manage robust operational processes that support organizational growth while maintaining high performance.
Strategic mindset focused on identifying efficiencies and driving continuous improvement across a national, high-volume provider network.
Advanced skill in detecting systemic operational and compliance risks within complex delivery models and implementing proactive safeguards.
Ability to bridge the gap between rigorous regulatory documentation requirements and a child-led, compassionate care model.
Proficiency in leveraging compliance frameworks not just as a "check-the-box" exercise, but as a tool to solve complex business problems.
Expert knowledge of ACQ coordination processes and the ability to lead initiatives that sustain industry-leading quality standards.
Demonstrated success in leading and mobilizing Subject Matter Experts (SMEs) to address and resolve multifaceted organizational challenges.
Ability to align diverse stakeholders around shared quality benchmarks and operational goals.
Capacity to view local issues through a national lens, ensuring consistency in care and compliance across all regions.
Excellent written and verbal communication skills for debriefing staff and writing reports.

Nice To Haves

Doctorate preferred
BCBA-D preferred

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.
Follow internal standards and requirements for reporting concerns to the appropriate leaders and facilities.
Follow up on reporting to ensure investigation, decision making, and resolution or key concerns.
Compliance with Centria’s Code of Conduct, policies and procedures, and Federal and State laws.
Responsibility to report violations of Company policies or the Code of Conduct.