Compliance Auditor Job Description template and pdf with duties [2024]

Job summary 1

The Compliance Auditor will report to Company’s Provider Coding Compliance Auditor. This role will be responsible for assisting in assigned chart compliance audits and training of Providers at OneOncology partnered practices, as assigned. The person in this role will be responsible for communicating and providing reports, as directed, to the Provider Coding Compliance Auditor, the Vice President of Compliance, the Vice President of Revenue Cycle, practice Revenue Cycle teams, practice Compliance Officers and when requested, practice management teams.

Duties & Responsibilities 1

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Resolves identified charging and coding issues.
Maintains a high level of education on new and updated regulations, and effectively applies the knowledge on current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the field of oncology.
Assists with third party payor and other audit requests by compiling, organizing, and reviewing chart documentation as needed.
Routinely performs Evaluation and Management (E/M), CPT coding audits and other projects related to provider coding compliance.
- Assists practice leadership to analyze data, identify issues, reach conclusions, and propose strategies for resolution of complex coding issues.
- Assists in the development of procedural manuals related to coding and billing compliance.
- Demonstrates outstanding work ethic and works cooperatively with all team members and management with a can-do spirit and team attitude.

Requirements & Skills 1

Job summary 2

We are looking for a highly motivated individual to join our team as a Compliance Auditor. This position is directly involved in negotiating the final determination of financial over-payments and recommending civil monetary penalties levied against providers participating in fraudulent billing practices. The information obtained by this position is used for a variety of activities such as: determination of fines, restitution and cost avoidance; internal deliberation's regarding settlement amounts for fines and restitution, participate in the decisions regarding opening and closing of criminal and civil investigations.

Duties & Responsibilities 2

Major duties and responsibilities include but are not limited to:
Complete required health care fraud audits regarding provider allegations, establish if program violations have occurred through billing, health care records, financial documentation, access to mainframe computer systems to include, but not limited to AHCCCS, DES, MVD and DPS
Research Policy, Contracts, Laws, Procedures and other documentation as it relates to health care fraud allegations
- Develop over-payment reports: losses to the Medicaid Program through diligent research and review
- Communicate effectively with providers, and contractors occasionally under adverse arid threatening circumstances. Authority to draft and serve subpoenas and take sworn statements
- Conduct interviews and obtain written statements from providers, and clients to determine if fraudulent activities have occurred

Requirements & Skills 2

Thorough knowledge of HIPAA and the rules pertaining to the sharing of investigative information
Skilled in: Written and verbal communication, Computing, summarizing, and aggregating qualitative and quantitative data in an accurate and timely manner, Investigative methods, techniques and approaches necessary to plan and conduct program compliance audits
- Interpreting and applying federal and state laws, rules, regulations, and procedures, Organizing, documenting and preparing investigative reports
- Ability to: Prepare written documentation in a clear and concise manner, and learn compliance as it relates to Healthcare, AHCCCS Providers, and AHCCCS member safety
- Two or more years of investigative experience preferably in healthcare, government, licensing, healthcare Insurance, or law enforcement. Certified Fraud Examiner (CFE), or Certified Professional Coder (CPC), AHIMA (CCA), Dental Hygienist (RHD) or Degree in Criminal Justice or other related field or Certification or experience in building code compliance and OSHA policy investigations.

Job summary 3

The Compliance Auditor leads audits, assessments, and regulatory readiness activities across the corporation. Participate in cross-divisional activities to integrate information from compliance audits and assessments and regulatory trends that may impact Company Divisions.

Duties & Responsibilities 3

Responsible for compliance with applicable Corporate and Divisional Policies and procedures.
- Ensure proactive determination of regulatory, compliance, quality issues and manage to integrate them into audits, assessments, and regulatory readiness activities on a priority basis.
- Ensure that compliance gaps with Corporate Policies are communicated assist with development and revisions to AQR policies by providing timely input and feedback.
- Identify serious compliance issues and risks so that they are understood; evaluate and provide feedback on adequacy of responses.

Requirements & Skills 3

Four-year degree in a scientific, technical, or compliance discipline or equivalent experience (e.g., six years experience in related field).
Individual must have excellent oral and written communication skills.
- Personal skills needed include tact, open-mindedness, maturity, tenacity, decisiveness, self-reliance and sound judgment.
- Persuasive, effective communication skills are essential with an ability to work effectively across divisional and technical areas.
- At least eight years in Quality Assurance or another function in the pharmaceutical, medical device, nutritional or related industry experience.

Job summary 4

Reporting to the Chief Compliance Officer, the Compliance Auditor will contribute to the overall success of the company's corporate compliance programs.

Duties & Responsibilities 4

Requirements & Skills 4

Minimum of 5 years working in a healthcare compliance auditor role
Bachelor’s Degree expected; advanced degree or relevant certifications preferred
Relevant work history in an ever-changing fast paced environment
Understands the paths of Risk Assessments
Comfortable using quality assuring software and data analysis
- Ability to work with multiple projects at one time and can discern where to focus energy when priorities complete or clash
- Proven track record of success and career progression in a team-oriented environment
- Experience in a growth by acquisition organization is a plus

Job summary 5

As a Compliance Auditor, you will perform compliance audits (generally in the field at employer locations) for various fringe benefit funds to determine if an employer is contributing properly to the benefit funds. Initial assignments will include assisting experienced compliance auditors on audit engagements and performing a wide range of audit support functions.

Duties & Responsibilities 5

Read collective bargaining agreements and understand the basis upon which contributions should be made
Prepare audit files, set up audit appointments and send confirmation letters to organizations being audited.
Review previous files (if any) to ensure any previous problems have been resolved
Perform fieldwork based on compliance audit program
- Prepare audit report and submit file for review
- Perform basic analysis and analytical review
- Revise report after review (if needed)

Requirements & Skills 5

Bachelors degree in a business related field. Accounting (Non-CPA path), Finance or business majors preferred OR Associates degree with at least 2 years professional work experience
Strong analytical, research and technical skills
Strong computer skills, experience with MS Excel and Word
Teamwork and communications skills (Oral and written)
- Detail oriented and able to handle numerous assignments
- Familiarity with payroll systems/business checking accounts is a plus
- Must have reliable transportation in order to drive to employer locations for audit assignments. Local travel will be required and out-of-town travel may be required at times

Job summary 6

Compliance Auditor performs fair, value-added audits, and consulting services to help ensure goals and performance objectives of the corporation are met and ensure compliance with standards and regulatory expectations.

Duties & Responsibilities 6

Requirements & Skills 6

Job summary 7

The Compliance Auditor maintain time sensitive, confidential information of guest and documentation. Reconcile assigned compliance, revenue, and cost center paperwork.

Duties & Responsibilities 7

Examine, prepare and maintain time sensitive, confidential documents required for filings
Communicate internal control problems to management
Audit and create daily MTL’s, TML’s, W2G, CTRCand file SARC, for Bank Secrecy Act, Title 31
Utilize all available information to track and report errors and unusual activity or transactions
Communicate exceptions to gaming departments and log for quarterly CTR meetings
Prepare tax request for guests and other agencies
- Review daily and monthly audits on taxable jackpots and withholding
- Facilitate external reviews by outside governmental agencies
- Assist in record retention and destruction

Requirements & Skills 7

2 year degree in Accounting; or a combination of equivalent experience and/or education
High attention to detail and accuracy
Strong computer skills Microsoft Office (Word, Excel and Outlook) and Windows XP
- High level organizational skills and ability to adapt quickly to changing priorities
- Excellent problem solving skills
- Above average math skills

Job summary 8

The Compliance Auditor is a highly visible operational position of the Corporate Quality Compliance Team. The role of the Compliance Auditor is to ensure that the company is adhering to all GMPs, FDA Regulations and Guidelines, state, federal, and local laws applicable to the business. The incumbent manages Company’s Internal Audit and Vendor Audit Programs for GMP, GDP and GLP compliance, working closely with the operational functions to define and review processes, procedures, and systems to be audited annually. The incumbent c oordinates and develops with GXP operational groups and Quality Systems a holistic Quality auditing strategy.

Duties & Responsibilities 8

Creates and executes a systematic approach to conduct all audits presenting findings and recommended changes to procedures or practices that are not in compliance with stated regulations and provides technical assistance to implement a plan to address such changes.
Manages and maintains the Internal Audit and Supplier/Vendor qualification program, including associated SOP’s, Approved Vendor List, and Vendor Quality Agreements reporting metrics to Site, Department and Quality management.
Completes and submits Internal and Supplier Audit reports as per the required deadlines established at the closure meeting requiring minimal edits from the approver.
Analyze potential risks within specific areas in order to avoid compliance issues. Performs general risk assessment studies to gauge the possible risk potential of vendors as required escalating critical findings to Corporate and Company Quality management.
Responsible for reviewing progress toward closure of audit findings and reporting the progress to appropriate management. Performs follow-up on all supplied information in order to perform verification checks on proposed corrective actions.
Supports readiness of the facility for Regulatory Inspection.
- Ensures timely completion of commitments from regulatory agency inspections and partner audits related to audit programs.
- Completes department related Change Controls, CAPAs and Deviations.
- Reviews and evaluates Internal and Vendor audit responses to determine acceptability of the response and any applicable CAPA plans. Performs follow up activity to ensure effective CAPA implementation that resolves and documents issues pertaining to the internal and supplier audits.

Requirements & Skills 8

Job summary 9

The Compliance Auditor is responsible for conducting internal audit and inspection assignments as defined by audit schedule. Contributor in assessing the overall compliance status of the facilities’ Quality Systems and Sub-Systems as well as supporting the overall success of hosted inspections. When serving as the lead auditor, provide mentorship capacity to other members of the audit team as needed. This individual will function as a compliance resource.

Duties & Responsibilities 9

Coordinate, execute, and perform auditor/lead audit functions during internal cGMP audits to assure compliance with applicable regulations and international laws and standards, guidelines, and procedures. Develop, implement, manage, and track effectiveness of corrective action plans for non-compliant issues, and provide management with regular updates.
Revise, review, and approve standard operating procedure change controls. Review and approve all plant SOPs, batch records and specifications for compliance to regulations, policies and procedures.
Perform key compliance projects including gap assessments to ensure compliance with regulatory requirements, including FDA, Health Canada, and other international audits as assigned.
Support compliance projects to achieve plant quality objectives and initiatives. Includes participation and contributions to committees/teams that support cGMP compliance programs.
Prepare for regulatory audits and participate in external audits. Assist in staffing and training audit support personnel. Track corrective action plans including the responses to observations, person responsible and target date(s) for completion.
- Perform on-floor spot audits as required.
- Ensure Audit Plan approvals are received, and Audit Responses completed within required time frames.
- Perform other related duties as assigned or required.

Requirements & Skills 9

A working knowledge of Quality tools, including statistical analysis.
Must possess and demonstrate the skill and ability to problem solve and critically think in order to understand connections between facts and resolutions.
Must have the ability to evaluate situations with an analytical view.
Working knowledge of current Good Manufacturing Practices and Good Documentation Practices.
Must have strong time management and organizational skills.
- Successful candidate must possess the ability to communicate with all levels of management and must possess the ability to work with and/or lead a cross functional team to perform audits and convey results in an effective manner to site management.
- Bachelor’s Degree is required: Quality Assurance, Regulatory Affairs, Engineering, other Scientific discipline.
- Minimum of two (2) years’ experience in a cGMP environment with at least one year serving in a Pharmaceutical or GxP regulated environment, Engineering, Validation principles, Pharmaceutical manufacturing methods, Quality Systems, Analytical or microbiological testing principles.

Job summary 10

The Compliance Auditor is well versed in healthcare regulations, policies, and procedures, and serves as a protector of revenue for the Healthcare System through the completion of formal audits and the provision of various advisory/consultative services. These audits provide insight into processes, internal controls, and related risk, and assist in preventing, detecting, and correcting risks of non-compliance. The Compliance Auditor reports on the results of audits and projects using knowledge of best practices to identify issues to improve business operations and minimize risk, and serves as a technical resource on documentation, coding, billing, and general compliance questions. Identifying, analyzing, and assessing complex enterprise-wide environment, responding to regulatory compliance inquiries and issues, and addressing compliance program needs are also functions of this position. The ideal candidate has excellent leadership and analytical thinking skills; excellent verbal and written communication skills; is flexible and adaptable; and experienced leading and managing compliance initiatives through teamwork, collaboration and open communication.

Duties & Responsibilities 10

Promotes personal and patient safety.
Uses effective customer service/interpersonal skills at all times.
Design and conduct audits and investigations for compliance with various regulatory requirements, which may include coding and billing rules set forth by Medicaid, Medicare, and commercial payers.
Perform all aspects of the audit including planning and developing the audit program, testing of controls, data analysis, and preparing accurate work papers to substantiate findings including any process gaps and deficiencies.
Generate final written report of audit findings and effectively communicate audit results to a wide audience of internal stakeholders including hospital service line administrators and management, physicians, coders, billing staff, and others as appropriate; evaluate the adequacy of management corrective action to the identified issues.
- Perform follow up procedures on the status of outstanding audit issues and validate that corrective action plans have been implemented and are effective.
- Establish trusted consultative/advisory relationships in order to serve as a resource for department managers, staff, physicians and administration for information on accurate/ethical coding and documentation standards, guidelines and regulatory requirements.
- Research various regulatory or other compliance related questions through the use of internet search engines, provider manuals, coding books, CMS websites and other tools, and prepare complete and accurate responses to stakeholders.

Requirements & Skills 10

Bachelor's degree required.
Minimum of four years of healthcare experience, preferably in compliance, coding and billing, medical record documentation, auditing, or other directly relevant areas.
Experience with EHRs, practice management systems, and reporting software is required.
Solid knowledge and ability to accurately interpret and implement Federal and State health care regulations, 3rd party payer standards, legal requirements, and policies and requirements pertaining to documentation, coding and billing.
Critical thinker with excellent research and analytical skills.
Self-starter with demonstrated leadership potential and strong time management skills.
- Excellent written and verbal communication skills; ability to effectively and collaboratively deal with conflicting views and mediate fair solutions at all levels in the organization, including clinical and nonclinical support staff, practice managers, physicians, and senior leadership.
- Proficient with computers and various Microsoft Office software, particularly Word, Excel, and
- PowerPoint. Must be adaptable to learning new software systems, including billing and clinical systems.

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