Compliance Auditor - (US-NC-Durham - 27722)

Minimum Education: None
Job Type: Full Time
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Responsibilities : .General Description of the Job ClassConduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, and anti-kickback and physician relationships. Interpretation of applicable federal and state law & regulations to plan audit parameters, determine department’s compliance with such regulations and communicate to department necessary changes in compliance with regulatory requirements.Duties and of this Level:Responsible for conducting non-routine audits, documenting & communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within DUHSConduct risk assessments and preparation of work plans.Develop an understanding of the operations, system processes and procedures used in areas being audited.Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents and investigation of irregularities and errors.Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.Develop recommended corrective actions to address issues detected.Actively participates in exit conferences, providing clarification and supporting information necessary.

Requirements :Bachelor’s degree in business administration, accounting, management, healthcare administration, nursing or other related degree.Experience4 years of experience related to legal, regulatory compliance, patient financial services or health information management services. Coding certification (e.g. CPC, CCS, RHIA, RHIT) and technical experience is strongly preferred. requires a broad knowledge of Medicare billing, coding and documentation requirement and ability to research efficiently such topics.Degrees, Licensures, CertificationsKnowledge of billing compliance, knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements.

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