Compliance Auditor

Provider Network Solutions LLC•Doral, FL

1d•$70,000 - $72,000

About The Position

The Compliance Auditor reviews the business practices of the company and its delegated entities for compliance with relevant federal and state regulations and standards, client contractual requirements, and internal policies and procedures. Audits and monitoring may occur annually or at other intervals and may involve reviewing documentation and records and interviewing executives and employees. When potential or current non-compliance is identified, the auditor recommends business-process improvements and evaluates implementation plans to ensure corrective steps are effective and address the root cause. The role supports internal and external audits, delegation oversight, compliance monitoring, issue remediation, and corrective action planning. It works closely with operational department leaders, delegated-entity points of contact, and the Compliance Officer; prepares findings and reports; maintains audit records and logs; and provides compliance training and guidance to staff and delegates.

Requirements

Requires 3–5 years of experience in operational audits, regulatory compliance, or government regulations, or an equivalent combination of education and experience.
Knowledge of Medicare, Medicaid, and Commercial regulations.
Experience in audits and monitoring processes.
Relevant experience in law, ethics, organizational business, finance, or statistical analysis.
Proficiency in Microsoft Office, including Word, Excel, and PowerPoint.
Excellent presentation skills.
Strong verbal and written communication skills, including the ability to communicate effectively with leadership and build relationships.
Ability to explain complex regulatory requirements clearly and concisely to varied audiences.
Excellent research and analytical skills.
Thorough understanding of business requirements and strong problem-solving skills.
Attention to detail and excellent organizational and time-management skills.
AI knowledge.

Nice To Haves

Bilingual written and spoken communication skills preferred.
Bachelor’s degree preferred.
Knowledge of the healthcare industry preferred.
Compliance certification strongly desired.

Responsibilities

Promote a strong code of ethics and integrity.
Monitor changes in healthcare laws, regulations, and standards, including Medicare, Medicaid, and Commercial regulations, and advise the company about requirements or changes to implement.
Assist with identifying and remediating risks and issues found through external audits, internal audits, and delegation oversight audits.
Resolve compliance issues identified through audits or monitoring in collaboration with operational department leaders and delegated-entity points of contact, ensuring prompt responses and effective procedures.
Monitor and maintain the quality of audited processes across departments in accordance with applicable lines of business and specialty networks, collaborating with the Compliance Officer to improve processes and mitigate risks.
Analyze, organize, and document audit and monitoring findings; prepare reports; and request and implement corrective action plans.
Conduct internal audits, develop quality indicators and internal audit tools as needed, and present evaluation results and audit reports to the Compliance Officer.
Handle and oversee external audits, including managing universes, questionnaires, samples, information requests, audit notices, recommendations, internal discussions, final-submission data preparation, and receipt of formal closing notices.
Maintain organized, up-to-date audit records in organizational systems.
Address corrective action plans and non-compliance issues identified through external audits with operational department leaders and delegate points of contact, and ensure complete, accurate, and effective evidence is provided to health plan partner auditors on time.
Maintain and organize the Audits and CAPs log and supporting evidence.
Follow organizational policies and procedures and contractual requirements, and serve as a departmental liaison supporting the Compliance Program.
Provide compliance-related training and guidance to staff and delegates.
Meet performance standards set by the Compliance department head.
Perform other duties as required and assigned.