The Compliance Auditor will develop audit programs for claims processing and business operations to ensure compliance with federal and state law requirements. This includes Federal requirements during patient registration, billing compliance for the 340B drug program, physician contracts, as well as billing compliance for radiology, pharmacy, and other ancillary service lines.
The Compliance Auditor will facilitate the annual compliance risk assessment and lead in the development of annual compliance work plans for NHRMC and PMH.
The Compliance Auditor will assess risks, identify trends, develop and execute appropriate tests of controls, present results and recommendations for improvements to management, and prepare audit reports.
Additionally, the Compliance Auditor conducts follow up and investigations on incident reports regarding patient privacy or security concerns and/or suspicious access identified. Under the leadership of the Compliance/Privacy Officer, the scope of the Compliance Auditor's role includes New Hanover Regional Medical Center, Pender Memorial Hospital, NHRMC Home Care, and the NHRMC Physician Group.
Under the oversight of the Compliance/Privacy Officer, the Compliance Auditor develops fiscal year Corporate Compliance Education Plan and delivers initial and ongoing compliance and privacy training to the workforce.
The Compliance Auditor will liaison with ancillary departments, Legal Affairs, Fiscal Service, Patient Financial Services, Patient Access Services, Revenue Recovery, Reimbursement, Health Information Management, and other departments and external parties to assure accurate claims submission.
1. The Compliance Auditor will work with multiple departments in the hospital to audit and/or evaluate compliance with federal and state rules and regulations.
2. The Compliance Auditor will track outstanding issues identified in compliance audits and issue reports and appropriate recommendations and/or conclusions to the Compliance/Privacy Officer, department leaders, and the Corporate Compliance Committee.
3. The Compliance Auditor will assist in the development, execution and follow-up of action plans, education to improve performance, and apply LEAN methodologies, as applicable.
4. The Compliance Auditor facilitates the annual compliance risk assessment process and leads the develop of annual compliance work plans for NHRMC and PMH. The Compliance Auditor ensures timely completion of all audit tasks assigned.
5. The Compliance Auditor will track, investigate, manage, and mitigate HIPAA Privacy incidents involving inappropriate access and disclosure of protected health information, complaints or breaches, including, but not limited to the coordination of investigations with leadership of respective departments. She/he will ensure all reports required under applicable privacy laws and regulations are completed and submitted in a compliant and timely manner, under the direction of the Compliance/Privacy Officer.
6. The Compliance Auditor will develop and conduct ongoing privacy and compliance training to the workforce, as well as promote activities to foster information privacy awareness within the organization, such as privacy assessments, tracers, newsletters, etc.
7. The Compliance Auditor will gather and report on specified financial and operational data as determined by the Compliance Officer for Compliance Program Work Plan audits, compliance tracer activities, and tracking and trending predefined Compliance data/ dashboard indicators.
8. The Compliance Auditor will compile, report and trend external agency Compliance concerns and requests, and perform investigations under the direction of the Compliance Officer
9. The Compliance Auditor serves as a resource for the organization regarding corporate compliance and privacy, acting under the direction of the Compliance/Privacy Officer.
10. The Compliance Auditor will participate in applicable compliance-related work teams and committees.
* Bachelors Degree
Experience: At least 5 years recent experience in auditing, claims processing, business management or hospital operations. Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.