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Position Summary:

The Compliance Auditor supports an effective compliance program by planning and executing risk-based audits, monitoring adherence to federal and state regulations, and evaluating internal controls and procedures. The role partners with departments across the organization to assess billing, coding, privacy/security, and operational practices; identifies vulnerabilities; and recommends corrective actions that promote ethical, compliant operations. The position prepares clear reports for leadership and supports survey readiness, investigations, and ongoing education to sustain compliance.

Qualifications:

+ Bachelor’s degree in healthcare administration, business, accounting, or related field.

+ Professional certification (e.g., Certified in Healthcare Compliance (CHC), Certified Professional Compliance Officer (CPCO)); or ability to obtain within twelve (12) months of hire.

+ Three (3) years of experience in healthcare compliance, auditing, or a related field.

+ Intermediate knowledge and experience reviewing clinical documentation, billing, and coding for compliance.

+ Intermediate knowledge and experience with electronic health records (EHR) systems (preferably Epic) and compliance/audit management tools.

+ Intermediate knowledge of CMS guidelines, payer requirements, HIPAA Privacy and Security Rules, and foundational healthcare regulations (e.g., Anti‑Kickback Statute, False Claims Act, EMTALA).

+ Intermediate proficiency with Microsoft Excel and report preparation; familiarity with statistical sampling methods for audits.

Preferred:

+ Master’s degree in healthcare administration, business, accounting, or related field.

+ Certified Professional Coder (CPC) or similar coding credential.

+ Prior experience supporting regulatory surveys/investigations and accreditation standards (e.g., Joint Commission, CMS Conditions of Participation).

+ Experience in small to mid-size healthcare organizations and with quality improvement methodologies.

Essential Job Functions: In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.

+ Develops and maintains a risk‑based annual audit plan aligned with organizational risks and OIG work plan priorities.

+ Conducts audits of clinical documentation, billing, coding, and operational processes to evaluate compliance with applicable laws, regulations, payer rules, and internal policies.

+ Reviews medical and billing records for coding accuracy and medical necessity; validates documentation sufficiency and identifies trends.

+ Monitors adherence to HIPAA privacy and security requirements, including appropriate handling of PHI and breach prevention practices.

+ Investigates reported compliance concerns and hotline allegations; documents findings, determines root causes, and recommends corrective actions.

+ Prepares clear, concise audit reports and dashboards; presents results and risk‑based recommendations to leadership and stakeholders.

+ Tracks and validates completion of corrective action plans (CAPs) to ensure timely and sustained remediation.

+ Supports preparation for and response to regulatory surveys, inquiries, and external audits; coordinates evidence collection and responses.

+ Maintains compliance data repositories, audit workpapers, and tracking systems with accurate, timely documentation.

+ Collaborates with departmental leaders to prioritize work, coordinate information requests, and minimize operational disruption during reviews.

+ Assists in developing and delivering compliance education for leaders, providers, and staff; supports onboarding and orientation activities.

+ Stays current on changes in healthcare regulations and payer policies; communicates impacts and updates procedures accordingly.

Knowledge, Skills and Abilities

+ Demonstrates sound judgment, patience, and maintains a professional demeanor at all times

+ Exercises tact, discretion, sensitivity, and maintains confidentiality

+ Performs essential job functions successfully in a busy and stressful environment

+ Learns current and new computer applications and office equipment utilized at Bozeman Health

+ Strong interpersonal, verbal, and written communication skills

+ Analyzes, organizes, and prioritizes work while meeting multiple deadlines

Schedule Requirements

+ This role requires regular and sustained attendance.

+ The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.

+ On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

+ Lifting (Rarely – 30 pounds): Exerting force and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.

+ Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.

+ Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.

+ Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination.

+ Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.

+ Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints.

+ Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.

+ Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.

+ Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.

+ Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.

+ Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.

+ Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses.

*Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%).

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.

77211350 Compliance