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Req. Number: 7382
Location: Chesapeake Regional Medical Center, Chesapeake, VA
Department: Administration
Education: Bachelor's Degree
Job Details:
  • Compliance Auditor will assist in the overall quality, compliance, and auditing activities to ensure compliance of standard operating procedures, corporate policies, industry standards, and applicable federal and state laws for Chesapeake Regional Healthcare (CRH). Conducts audit activities and prepares reports summarizing audit results. Reports to and works with the Chief Corporate Compliance Officer on compliance work plans, staff education, internal and external audits and reviews, and provides assurance that the CRH is operating in an efficient and effective manner.

    The Compliance Auditor will provide an independent and objective assessment of CRH's operations, specifically the effectiveness of its internal control structure.


    Essential Duties and Responsibilities

    These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.


    ·         Objectively reviews CRH's business processes to ensure processes are in placed to protect against fraud and theft of the organization's assets.

    ·         Evaluates the efficacy of risk management procedures.

    ·         Manages compliance audit and monitoring activities pertaining to compliance and coordinates with the Chief Financial Officer and Chief Corporate Compliance Officer as it relates to such audits.

    ·         Collaborates with Chief Financial Officer and Chief Corporate Compliance Officer on external audits and reviews, which are initiated by government agencies or government-contracted organizations.

    ·         Coordinates medical record and claim reviews with the CRH clinical and revenue cycle departments.

    ·         Performs monthly audits according to the established work plan and calendar and prepares work plan summary slides with appropriate corrective action plans.

    ·         Modifies work plan calendar through the year to include additional audits, based on audit results, risks, and corrective action plans.

    ·         Assists the Compliance Committee and presents summary of audit activities to the committee.

    ·         Provides subject matter expertise to CRH staff as directed by the Chief Corporate Compliance Officer.

    ·         Exercises due diligence in collaboration with Chief Corporate Compliance Officer to prevent and detect misconduct and wrongdoing. Undertake all reasonable steps to respond appropriately when a violation is detected and prevent future similar occurrences. Ensure the enforcement of compliance program standards.

    ·         Provides results of audits and education to HIM, Revenue Cycle Departments, physicians, hospital and clinic operations regarding charging, documentation, and billing requirements.

    ·         Assists department with development of corrective action plans (CAPs), as needed, and ensure CAPs are implemented and successful by performing follow up audits.

    ·         Communicates effectively with the Corporate Compliance team and hospital departments following the CRH Core Values.

    ·         Assists Chief Corporate Compliance Officer on OIG and other government audits/reviews and other compliance-related work, as assigned.

    ·         Maintains confidentiality and discretion regarding all work matters. Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.

    ·         Ensures compliance with all policies, procedures, and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.

    ·         Obtains annual Conflicts of Interest Annual Disclosure Statement from leadership.


    Candidate Attributes: The ideal candidate will:

    ·         Pay close attention to detail and strive for excellence.

    ·         Possess curiosity for learning CRH's business, products and solutions.

    ·         Thrive in a dynamic environment by practicing effective time management and prioritization.

    ·         Comfortable in making recommendations in contractual matters.

    ·         Effectively assist cross-functional projects to completion.

    ·         Display strong communication and writing skills.

    ·         Display excellent judgment and strong organizational skills

    ·         Possess a willingness and ability to work and coordinate activities across a large number of individuals in various departments.


    Supplemental Functions:

    ·         Conduct special projects as assigned.



    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


    ·         Bachelor's degree in business, accounting and/or healthcare administration is preferred

    ·         Extensive experience in healthcare revenue cycle, auditing, clinical operations and/or compliance preferred. 

    ·         Knowledge of and experience with EPIC and Athena preferred.

    ·         Strong Skills with Microsoft products (Excel, Word, and Power Point)



    ·         Five (5) years' experience or more in healthcare revenue cycle or compliance.

    ·         Knowledge with healthcare compliance and integrity policies required.

    ·         Strong knowledge of DRG, CPT, CDM and billing operations required.

    ·         Overall knowledge of hospital department operations.


    C. Licenses, Registrations, or Certifications

    ·         Health Care Compliance Association (HCCA) membership and certification preferred.

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