The Compliance Auditor helps to ensure that the organization is in compliance with all Local, State, and Federal laws, rules, and regulations by conducting compliance audits and assisting with internal monitoring activities pursuant to the corporate Compliance Program. The Auditor executes audits as directed, evaluates and tracks corrective actions, and provides compliance audit and monitoring support to various functional units of the organization.
- Execute internal compliance audits to systematically review specific functional areas of the organization for compliance with applicable laws, regulations, policies, procedures, and the Company’s Compliance Program requirements, specifically in the areas of Medicare Advantage, PACE and Managed Long Term Care.
- Conduct internal audit interviews with Department Heads when necessary for completing assigned audit work.
- Prepare audit work papers and reports to effectively conduct, document, and communicate all compliance audit activities. Compose audit reports which accurately outline any findings as a result of the audit work.
- Meet with Department Heads and Executives to review audit reports, discuss findings, and request corrective action plans.
- Review corrective action plans received in response to audit findings; collaborate with the submitting department on any necessary changes.
- Track corrective actions and follow-up with responsible parties to ascertain completion status. Report deficiencies or roadblocks to Compliance Officer and collaborate on actions needed for the responsible parties to successfully complete requirements to achieve compliance.
- Review corrective action plan evidence to assess whether all corrective actions were taken appropriately and that the evidence demonstrates compliance with all applicable regulations.
- Compile data to report on audits performed, findings, level of risk, corrective action plans, and outcomes. Assist in evaluating the effectiveness of the audit program.
- Conduct audits of the first tier, downstream, and related entities (FDRs) in collaboration with the Vendor Oversight team, to confirm compliance with applicable laws, regulations, policies, procedures, and CenterLight’s Compliance Program requirements.
- Participate in risk assessment activities and assist with the development of an annual audit plan that identifies and prioritizes areas of significant compliance risk.
- Assist with internal monitoring initiatives.
- Assist in preparation for and coordinating regulatory audits.
- Maintain education, awareness, and knowledge of current regulations and best practices in the health care industry and in the audit and monitoring function. Bring regulatory changes and matters of significance or urgency to the attention of applicable departments.
- Continuously communicate the message of compliance in all interactions with others. Assist in compliance awareness, training, and education initiatives by contributing to the Compliance Department educational actitivites, participating in educational activities and events, and other activities as requested or developed.
- Other related duties as assigned to meet departmental and Company objectives.
- Bachelor’s degree in business or a related field.
- Minimum 3 years experience in a managed care, health care, insurance, or other federally regulated environment, in a role that required interpreting, understanding, and implementing government regulations.
- Working knowledge of compliance audit and monitoring techniques and standards, including use of web-based audit and monitoring applications or the ability to quickly learn such applications.
- Understanding of the risks and controls associated with healthcare regulatory compliance processes and the ability to identify those risks and controls.
- Knowledge of Medicare Advantage and Part D regulatory requirements, Medicaid, PACE and MLTC. Ability to research, read, analyze, and interpret State and Federal laws, regulations, and standards.
- Excellent written and verbal communication and presentation skills, with ability to effectively and professionally communicate with individuals at all levels of the organization, as well as external parties.
- Excellent problem-solving skills.
- Analytical skills, including research skills, with ability to interpret data, analyze and disseminate information in a readily understandable manner.
- Proven investigatory skill; ability to organize, analyze, and effectively determine risk with corresponding solutions.
- Ability to plan proactively and interpret complex processes and programs. Excellent follow-up skills to keep projects and tasks on track.
- Energetic and forward thinking with high ethical standards and a professional image.
- Collaborative and team-oriented.
- Ability to meet stringent deadlines, multi-task, perform a high volume of activities, prioritize work, and respond to changing demands.
- Proficiency using Microsoft Office software applications, including Word, Excel, and Power Point; adept at learning and utilizing database and document repository applications; proficient in report development.