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JOB PURPOSE:

The Compliance Auditor will foster an environment that enhances and promotes compliance and adherence to all relevant federal, state, and local laws, rules and regulations applicable PACE, Part D, LHCSA and Article 28 requirements, etc., through audits. The Compliance Auditor is r esponsible for performing internal and external auditing functions for the Compliance Department of CenterLight.

JOB RESPONSIBILITIES:

+ The Compliance Auditor utilizes regulatory expertise to conduct effective risk assessments and assist in preparing annual audit plan.

+ Develop comprehensive audit programs to address risks and evaluate compliance with governmental or other regulatory requirements.

+ Assess control weaknesses by conducting independent audits according to the annual audit plan and develop appropriate documentation to support audit work performed.

+ Use information effectively to support a viable position.

+ Make self-available to help others solve problems.

+ Measure and track results of audits performed through action plan follow-up.

+ Maintain current knowledge base of governmental and regulatory requirements and provide education to management and governance as needed concerning organization risks and their potential impact.

+ Perform other duties as required, consistent with the goals, objectives and responsibilities of the Compliance department.

QUALIFICATIONS:

Education: B achelor’s degree in business, finance, health care operations or a clinical field required.

Experience:

+ Minimum of three (3) years Healthcare Audit background preferably in a Health Insurance Plan

+ Understanding of Medicare and Medicaid programs strongly preferred.

+ An in-depth understanding of the industry's rules, guidelines, and regulations.

+ Billing and Coding experience, preferred.

+ Strong attention to detail, analytical, and statistical skills.

Physical Requirements

Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:

+ Standing – duration of up to 6 hours a day

+ Sitting/Stationary positions – sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods.

+ Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc.

+ Bending/Squatting – have to be able to safely bend or squat to perform the essential functions under the scope of the job.

+ Stairs/Steps/Walking/Climbing – must be able to maneuver stairs safely, climb up/down and walk to access work areas.

+ Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.)

+ Sight/Visual Requirements – must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc.

+ Audio Hearing and Motor Skills (language) Requirements – must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual.

+ Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):$90,000.00 - $100,000.00