COMPLIANCE AUDITOR

C2Q Health Solutions•New York, NY

20h•Onsite

About The Position

The Compliance Auditor will foster an environment that enhances and promotes compliance and adherence to all relevant federal, state, and local laws, rules and regulations applicable PACE, Part D, LHCSA and Article 28 requirements, etc., through audits. The Compliance Auditor is responsible for performing internal and external auditing functions for the Compliance Department of C2Q Health Solutions.

Requirements

Bachelor’s degree in health care administration, political science, social science or related field required.
Minimum of three (3) years Healthcare Audit background preferably in a Health Insurance Plan
An in-depth understanding of the industry's rules, guidelines, and regulations.
Strong attention to detail, analytical, and statistical skills.

Nice To Haves

Understanding of Medicare and Medicaid programs is strongly preferred.
Billing and Coding experience, preferred.

Responsibilities

Assist in conducing enterprise‑wide risk assessments and actively contribute to the development and execution of the annual compliance audit plan.
Design and implement comprehensive, risk‑based audit programs to assess compliance with governmental, contractual, and regulatory requirements.
Perform independent audits and monitoring activities in accordance with the approved audit plan, ensuring appropriate scope, testing, and documentation.
Identify root causes, and systemic compliance risks; clearly document observations and support findings with defensible evidence.
Communicate audit results effectively, using data and analysis to support conclusions and recommendations.
Partner with operational leaders to develop, track, and validate corrective action plans, ensuring timely and sustainable remediation.
Monitor audit outcomes and trends, reporting progress and residual risk to compliance leadership and governance as appropriate.
Maintain high-level knowledge of applicable laws, regulations, and guidance, and provide targeted education and advisory support to management and stakeholders.
Serve as a compliance resource by being accessible, collaborative, and solution‑oriented.
Perform additional duties as assigned in alignment with the goals, and responsibilities of the Compliance Department.