Compliance Auditor

Swope Health • Kansas City, MO

5d

About The Position

The Compliance Auditor is responsible for developing and managing an annual audit plan based on measured risk assessments. This individual will complete compliance audits which includes Developing audit tools and methodologies, conducting entrance conference to explain the audit purpose, scope, and applicable laws/standards. It also includes obtaining the necessary information and data to conduct the audit, including reviewing records and reports. Analyzing the information to determine if it meets the standard and drafting detailed written reports that explain the standards and the audit findings. Including recommendations of corrective action and continued monitoring and presenting the findings/recommendations at an exit conference. Successful Candidate will have: Identify applicable laws, standards, and program requirements, including Department of Mental Health licensure and certification requirements, Health Resources and Service Administration (HRSA) requirements, and The Joint Commission’s National Patient Safety Goals and accreditation standards, Fraud Waste and Abuse laws, and appropriate Coding and Billing. Lead specific internal audits of internal business units to investigate adherence with policies, procedures, and regulatory requirements. This includes thoroughly researching regulations, standards, and policies and then reviewing records, reports, and other relevant sources of information to measure business compliance. Assess level of risk associated with noncompliance and provide detailed written reports, tools, data, and education. Assist in the development of action plans and monitor progress on such action plans that result from internal audits or external audits, certification, and accreditation surveys. Develop, annually, a compliance audit schedule delineating the priority areas for review based on level of risk. The level of risk should be based on completed risk assessments and audits. Work to the annual work plan and manage resources such that the work plan is completed in a timely manner. Assist in the development of the annual risk assessment, and coordinate with business leaders to conduct questionnaires, analyze results and ultimately assess risk. Serve as a resource to the Director of Compliance and external auditors during site surveys and fulfill all documentation requests. Conduct root cause and failure mode analysis. Assist in the development and revision of policies and procedures that will result in compliance. Assist in monitoring the implementation of best clinical practice guidelines and evidence-based practices. Perform other duties as assigned.

Requirements

• A Master’s degree in Business Administration, Health Administration, or closely related areas. Related training and education beyond a Bachelor’s degree may be substituted.
• Three years of experience and skill in research, auditing, and development of reports to support compliance activities.
• Strong research, writing, and report generating skills
• Experience utilizing Electronic Health Records/Electronic Medical Records.
• Working knowledge of the Missouri Code of State regulations, Joint Commission Standards, Health Resources & Services Administration (HRSA) requirements, and Health Insurance Portability and Accountability Act (HIPAA) regulations.

Responsibilities

• Developing audit tools and methodologies
• Conducting entrance conference to explain the audit purpose, scope, and applicable laws/standards
• Obtaining the necessary information and data to conduct the audit, including reviewing records and reports
• Analyzing the information to determine if it meets the standard and drafting detailed written reports that explain the standards and the audit findings
• Including recommendations of corrective action and continued monitoring and presenting the findings/recommendations at an exit conference
• Identify applicable laws, standards, and program requirements, including Department of Mental Health licensure and certification requirements, Health Resources and Service Administration (HRSA) requirements, and The Joint Commission’s National Patient Safety Goals and accreditation standards, Fraud Waste and Abuse laws, and appropriate Coding and Billing
• Lead specific internal audits of internal business units to investigate adherence with policies, procedures, and regulatory requirements
• Thoroughly researching regulations, standards, and policies and then reviewing records, reports, and other relevant sources of information to measure business compliance
• Assess level of risk associated with noncompliance and provide detailed written reports, tools, data, and education
• Assist in the development of action plans and monitor progress on such action plans that result from internal audits or external audits, certification, and accreditation surveys
• Develop, annually, a compliance audit schedule delineating the priority areas for review based on level of risk
• Assist in the development of the annual risk assessment, and coordinate with business leaders to conduct questionnaires, analyze results and ultimately assess risk
• Serve as a resource to the Director of Compliance and external auditors during site surveys and fulfill all documentation requests
• Conduct root cause and failure mode analysis
• Assist in the development and revision of policies and procedures that will result in compliance
• Assist in monitoring the implementation of best clinical practice guidelines and evidence-based practices
• Perform other duties as assigned

Benefits

• Medical benefits (including a Health Savings Account option), dental and vision
• 401(k) retirement plan with company match
• Company-paid benefits such as life insurance, Accidental Death & Dismemberment, and Short- and Long-Term Disability
• Flexible Spending Account
• Paid Days Off beginning at 12 days annually, effective the first day of employment
• Eight annual company-paid holidays
• One annual paid personal day

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level