Compliance Auditor

Marin Community Clinics•Novato, CA

12d

About The Position

Marin Community Clinics, founded in 1972, is today, a multi-clinic network with a wide array of integrated primary care, dental, behavioral, specialty and referral services. As a Federally Qualified Health Center (FQHC), we provide vital health services to almost 40,000 individuals annually in Marin County. The Clinics regularly receive national awards from the Health Resources and Services Administrations (HRSA). Our Mission is to promote health and wellness through excellent, compassionate care for all. The Compliance Auditor supports Marin Community Clinics’ compliance, risk management, and quality programs by performing independent audits, monitoring activities, and data validation to ensure adherence to federal and state regulations. This includes HRSA Health Center Program requirements, FTCA, CMS billing and documentation rules, Medi-Cal, TJC standards, HIPAA/HITECH, 42 CFR Part 2, California health laws, and internal policies. The role works closely with clinical, operational, billing, dental, behavioral health, specialty, and administrative teams to identify gaps, validate corrective actions, ensure MCC is audit ready, and ensure continuous improvement in compliance, quality, and patient safety.

Requirements

Bachelor’s degree education in health-care administration, health information management or law is required.
Minimum 2–4 years of experience in health-care compliance, coding/billing auditing, documentation review, or quality improvement.
FQHC, ambulatory care setting, or multisite clinic environment strongly preferred.
Working knowledge of Medi-Cal, CMS, HRSA, FTCA, and CA-specific health-care regulations.
Strong understanding of HIPAA, HITECH, 42 CFR Part 2, CMS Billing Guidelines, Medi-Cal requirements, Cal/OSHA, and TJC standards.
Coding knowledge (ICD-10, CPT, HCPCS, CDT, DSM-5).
Excellent analytical, critical thinking, communication, and report-writing skills.
Ability to manage multiple audits simultaneously.
Ability to maintain confidentiality and professionalism at all times.
Proficiency using EHRs (Epic, eCW, Dentrix, etc.), audit tools, spreadsheets, and dashboards.
Fulfill Immunization and fit for duty regulatory requirements.
Ability to sit, stand, and walk for extended periods.
Ability to lift up to 20 lbs.

Nice To Haves

Master’s degree level in related field is preferred.
Relevant professional certifications a plus.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA)
Certified in Healthcare Compliance (CHC), or equivalent
Dental coding certification a plus
QI, risk management, or safety certification is a plus

Responsibilities

Compliance Auditing & Monitoring Conduct audits across medical, dental, behavioral health, specialty, and billing workflows.
Evaluate documentation, coding, billing accuracy, and alignment with CMS, Medi-Cal, and HRSA requirements.
Audit privacy/security compliance (HIPAA, HITECH, 42 CFR Part 2), telehealth consent, and minimum necessary requirements.
Perform FTCA-related audits, including credentialing/privileging, QI, incident reporting, and OB risk processes.
Review compliance with TJC standards and adherence to California laws and regulations.
Regulatory & Policy Compliance Audit adherence to internal policies, workflows, and operational procedures.
Incorporate regulatory updates (OIG, CMS, HRSA, and California) into audit tools.
Support HRSA Site Visit Protocol (SVP) monitoring.
Data Review & Reporting Develop audit tools and sampling methodologies.
Produce clear audit reports outlining findings, trends, risk levels, and recommendations.
Present results to leadership and committees; track corrective actions.
Risk Identification & Mitigation Identify regulatory, financial, operational, and clinical risks and escalate issues appropriately.
Recommend corrective action that support Just Culture and patient safety.
Participate in root cause analysis (RCA) and after-action reviews.
Training, Education & Technical Support Provide targeted feedback and education based on audit findings.
Support development of compliance training modules and department workflows.
Continuous Quality Improvement Validate quality measure documentation (UDS, HEDIS, CalAIM, dental and behavioral health metrics) and workflow adherence.
Support performance improvement plans and monitor sustainability.
Additional Duties Maintain audit logs, dashboards, CAP tracking, and trend reports.
Support compliance hotline review, investigations, and regulatory survey preparation (HRSA, OSV, TJC, FTCA, CDPH, payer audits, etc).
Participate in cross-functional meetings as needed.
Additional duties as assigned.