PURPOSE AND SCOPE:

Assists with the assessment of compliance risks and controls, and compliance policies and procedures. Conducts compliance audits to assess the adequacy of compliance with internal controls, applicable regulations, laws, and standard operating procedures.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Assists with the development of the annual Compliance Audit Plan.
• Maintains policies and procedures for the general operation of the Compliance Program to prevent illegal, unethical and/or improper conduct.

• Manages, plans, supervises and/or conducts scheduled and non-scheduled compliance audits according to the audit plan while testing compliance with all pertinent federal, state and local regulations and standards.
  • Develops audit programs to identify areas of risk to be addressed, and detail the steps to be taken.
  • Evaluates the areas of risk to be addressed by each audit. Tests the system of internal controls.
  • Reviews compliance with existing policies and procedures by performing the required audit steps.
  • Examines data for proper documentation in auditing billing groups, clinics and other businesses.
• Prepares and/or reviews audit reports based on audit findings derived from and supported by the audit work papers.
  • Documents procedures and findings in all the test areas.
  • Provides recommendations requiring management responses to address the identified findings.

• Conducts audit exit meetings to review audit report findings.
  • Discusses findings with local management (i.e. people audited) and other affected management.
  • Discusses possible management responses to ensure management understands the implications of the findings so that they can respond appropriately.
  • Assists with the research and resolution of issues and answer questions related to the audit findings.
  • Makes recommendations for process improvements as needed.

• Reviews management responses to determine if recommendations have been satisfactorily addressed.
• Addresses responses requiring further clarification.
• Coordinates with other audit departments throughout the company to eliminate duplication of audit efforts.
• Supports Compliance Officers with creating self-monitors and the validation of the testing results.
• Serves as resource to the Compliance Officers.
• Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors.
• Demonstrates good judgement in selecting methods and techniques for obtaining solutions.
• Participate in professional conferences, to maintain up-to-date knowledge of compliance/audit/regulator y rules, regulations, priorities and tools.
• Provides assistance to junior level staff with general tasks that require a better understanding of functions, as directed by immediate supervisor.
• Assists with day-to-day supervision of staff auditors.
• May refer to senior level staff for assistance with higher level problems that may arise. Escalates issues to supervisor/manager for resolution, as deemed necessary.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Receives little instruction on day-to-day work, general instructions on new assignments. Other duties as assigned, including department wide projects.
• Up to 20% travel required.

EDUCATION:

• Bachelor's Degree required; Advanced Degree/healthcare experience preferred

EXPERIENCE AND REQUIRED SKILLS:

• 6 - 12 years' related experience
• Previous experience in regulatory/compliance audits preferred.
• Knowledge of statistical auditing methods
• Superior ability to communicate orally and in writing to individuals and groups from varied disciplines and levels of management.
• Excellent analytical, problem solving, organizational skills required.
• Personal tenacity, team leadership skills and the ability to foster change.
• Strong computer skills with proficiency in Microsoft Office applications.