2,681 Compliance Auditor jobs in the United States
Compliance Auditor
46202 Indianapolis, Indiana
Labcorp
Posted 2 days ago
Job Viewed
Job Description
If you have a passion for compliance auditing and a drive for operational excellence, join our growing Quality team as a **Compliance Auditor** and take your career to the next level at Labcorp.
**This is an Onsite position at 8211 Scicor Drive, Indianapolis, IN.**
Imagine being involved in innovation and projects that change the course of our industry daily! At Labcorp, one of the world's largest and most comprehensive pharmaceutical solutions service companies, you will have an opportunity to build an exciting career while you make a direct impact on the lives of millions.
**Job Summary:**
We are seeking an experienced member to join our Quality Assurance team. The Compliance Auditor plays a pivotal role in ensuring that clinical research laboratory testing operations comply with global regulatory standards and industry-recognized best practices, including GCP/GLP, ISO 15189, and ISO 13485. This position leads the internal audit program execution, drives process improvements, collaborates with management to implement audit strategies, mentors' junior auditors, and collaborates with cross-functional teams to uphold quality and regulatory integrity across clinical laboratory testing and operational environments. The ideal candidate will possess strong leadership skills, a keen eye for detail, and the ability to oversee complex audit functions in a fast-paced environment with minimal direction. This role requires proactive, timely and responsive engagement with stakeholders, ensuring compliance with industry regulations and internal standards while continuously improving auditing processes.
**Essential Functions:**
**Managing the Internal Audit Program:**
+ Plan and implement the internal audit program.
+ Schedule and oversee the approved audit program.
+ Develop and clarify audit scopes to ensure comprehensive assessments.
+ Approve and assign internal audits to appropriate team members.
**Preparedness and Oversight:**
+ Ensure appropriate stakeholder engagement throughout the audit process.
+ Facilitate effective planning and communication with all relevant parties.
**Audit Hosting & Regulatory Support:**
+ Serve as the primary host for internal audits.
+ Provide regulatory inspection support and host sponsor audits as required.
**Severity Finding and Audit Report Review with Management:**
+ Document audit findings and develop detailed reports with actionable recommendations.
+ Collaborate with stakeholders to implement CAPAs and monitor their effectiveness.
+ Lead audit review meetings and collaborate with management to address compliance gaps.
**Audit Program Monitoring:**
+ Lead and manage monthly audit meetings.
+ Monitor audit activities, ensuring alignment with regulatory requirements.
+ Ensure audit and regulatory inspection readiness, in harmony with CLS QA programs and global processes
**Internal Auditor Development:**
+ Provide training and mentorship for internal auditors.
+ Collaborate with QA management and Regulatory Intelligence to ensure regulatory updates are proceduralized, and embraced through staff training and team huddles.
+ Develop audit leads and ensure continuous professional development and compliance awareness.
**Quality Assurance (QA) Support:**
+ Support, lead and participate in QA projects as needed to uphold compliance standards and continuous improvement strategic initiatives.
**Preferred Skills & Qualifications:**
+ Strong written and verbal communication skills.
+ Excellent organizational and project management abilities.
+ Strong negotiation, influencing and networking skills.
+ Demonstrative skills include risk management application experience including risk-based auditing methodologies
+ Experience in training and developing internal auditors.
+ Laboratory / Quality background specifically with ISO 15189/ISO 13485 standards.
+ Experience with quality management system and regulatory compliance inspections
+ Experience with compliance software such as Veeva or Trackwise.
**Recommended Certifications:**
+ ASQ Quality Auditor Certification
+ ASQ Quality Manager Certification
+ ASQ Quality Engineer Certification
If you have a passion for compliance auditing and a drive for operational excellence, we invite you to apply for this exciting opportunity.
**Education/Experience Requirements:**
+ Minimum of a Bachelor's degree in a Pharmacy, Chemistry or Biology related discipline Postgraduate degree (MSG or equivalent) in science or management related discipline, preferable. Experience may be substituted for education.
+ Minimum of 8 years in regulatory environment (experience in GXP roles)
+ Regulatory expertise - detailed knowledge of specific regulation/ multiple regulations
+ Experienced Lead Auditor with strategic communication with clients
+ Experience leading process improvement initiatives
**Benefits:** Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here ( **.**
**Why People choose to work at Labcorp:**
At Labcorp, it is our people that make us great - it is what our clients, our partners and, most importantly, what our employees say. Here, you will have the opportunity to collaborate with extraordinary people with diverse viewpoints. You will discover your own outstanding potential as we build an even stronger organization with industry leaders from early development to the clinic and beyond. We help our clients develop medicines that improve health and improve lives of their family and friends.
**Labcorp is proud to be an Equal Opportunity Employer:**
Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law.
**We encourage all to apply**
If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site ( or contact us at Labcorp Accessibility. ( ) For more information about how we collect and store your personal data, please see our Privacy Statement ( .
**This is an Onsite position at 8211 Scicor Drive, Indianapolis, IN.**
Imagine being involved in innovation and projects that change the course of our industry daily! At Labcorp, one of the world's largest and most comprehensive pharmaceutical solutions service companies, you will have an opportunity to build an exciting career while you make a direct impact on the lives of millions.
**Job Summary:**
We are seeking an experienced member to join our Quality Assurance team. The Compliance Auditor plays a pivotal role in ensuring that clinical research laboratory testing operations comply with global regulatory standards and industry-recognized best practices, including GCP/GLP, ISO 15189, and ISO 13485. This position leads the internal audit program execution, drives process improvements, collaborates with management to implement audit strategies, mentors' junior auditors, and collaborates with cross-functional teams to uphold quality and regulatory integrity across clinical laboratory testing and operational environments. The ideal candidate will possess strong leadership skills, a keen eye for detail, and the ability to oversee complex audit functions in a fast-paced environment with minimal direction. This role requires proactive, timely and responsive engagement with stakeholders, ensuring compliance with industry regulations and internal standards while continuously improving auditing processes.
**Essential Functions:**
**Managing the Internal Audit Program:**
+ Plan and implement the internal audit program.
+ Schedule and oversee the approved audit program.
+ Develop and clarify audit scopes to ensure comprehensive assessments.
+ Approve and assign internal audits to appropriate team members.
**Preparedness and Oversight:**
+ Ensure appropriate stakeholder engagement throughout the audit process.
+ Facilitate effective planning and communication with all relevant parties.
**Audit Hosting & Regulatory Support:**
+ Serve as the primary host for internal audits.
+ Provide regulatory inspection support and host sponsor audits as required.
**Severity Finding and Audit Report Review with Management:**
+ Document audit findings and develop detailed reports with actionable recommendations.
+ Collaborate with stakeholders to implement CAPAs and monitor their effectiveness.
+ Lead audit review meetings and collaborate with management to address compliance gaps.
**Audit Program Monitoring:**
+ Lead and manage monthly audit meetings.
+ Monitor audit activities, ensuring alignment with regulatory requirements.
+ Ensure audit and regulatory inspection readiness, in harmony with CLS QA programs and global processes
**Internal Auditor Development:**
+ Provide training and mentorship for internal auditors.
+ Collaborate with QA management and Regulatory Intelligence to ensure regulatory updates are proceduralized, and embraced through staff training and team huddles.
+ Develop audit leads and ensure continuous professional development and compliance awareness.
**Quality Assurance (QA) Support:**
+ Support, lead and participate in QA projects as needed to uphold compliance standards and continuous improvement strategic initiatives.
**Preferred Skills & Qualifications:**
+ Strong written and verbal communication skills.
+ Excellent organizational and project management abilities.
+ Strong negotiation, influencing and networking skills.
+ Demonstrative skills include risk management application experience including risk-based auditing methodologies
+ Experience in training and developing internal auditors.
+ Laboratory / Quality background specifically with ISO 15189/ISO 13485 standards.
+ Experience with quality management system and regulatory compliance inspections
+ Experience with compliance software such as Veeva or Trackwise.
**Recommended Certifications:**
+ ASQ Quality Auditor Certification
+ ASQ Quality Manager Certification
+ ASQ Quality Engineer Certification
If you have a passion for compliance auditing and a drive for operational excellence, we invite you to apply for this exciting opportunity.
**Education/Experience Requirements:**
+ Minimum of a Bachelor's degree in a Pharmacy, Chemistry or Biology related discipline Postgraduate degree (MSG or equivalent) in science or management related discipline, preferable. Experience may be substituted for education.
+ Minimum of 8 years in regulatory environment (experience in GXP roles)
+ Regulatory expertise - detailed knowledge of specific regulation/ multiple regulations
+ Experienced Lead Auditor with strategic communication with clients
+ Experience leading process improvement initiatives
**Benefits:** Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Casual, PRN & Part Time employees regularly scheduled to work less than 20 hours are eligible to participate in the 401(k) Plan only. For more detailed information, please click here ( **.**
**Why People choose to work at Labcorp:**
At Labcorp, it is our people that make us great - it is what our clients, our partners and, most importantly, what our employees say. Here, you will have the opportunity to collaborate with extraordinary people with diverse viewpoints. You will discover your own outstanding potential as we build an even stronger organization with industry leaders from early development to the clinic and beyond. We help our clients develop medicines that improve health and improve lives of their family and friends.
**Labcorp is proud to be an Equal Opportunity Employer:**
Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law.
**We encourage all to apply**
If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site ( or contact us at Labcorp Accessibility. ( ) For more information about how we collect and store your personal data, please see our Privacy Statement ( .
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0
Compliance Auditor
Wisconsin, Wisconsin
Sanford Health
Posted 16 days ago
Job Viewed
Job Description
**Careers With Purpose**
**Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.**
**Facility:** Remote WI
**Location:** Remote, WI
**Address:**
**Shift:** 8 Hours - Day Shifts
**Job Schedule:** Full time
**Weekly Hours:** 40.00
**Salary Range:** 19.00 - 30.50
**Job Summary**
Responsible for conducting internal audits and monitors to ensure that the organization's processes and operations are in compliance with laws, corporate guidelines, best practices, and contractual agreements. Knowledgeable of general audit concepts and techniques, including the type of audits, the approaches and processes, and the subsequent activities, as they relate to internal audits. Demonstrates the ability to interpret Federal rules and regulations. Demonstrates the ability to research regulation from various data sources. Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) code assignment. Demonstrates both knowledge and application of Sanford Health Systems, policies, procedures, and guidelines. Demonstrates commitment to continuous learning for themselves and performs as a role model to other coding staff.
**Qualifications**
High school diploma or equivalent preferred. Advanced diploma or degree in Health Information Management or healthcare related field is preferred.
Prior relevant compliance work experience is preferable. Two years' experience is required.
Certification in one of the following is required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or an equivalent. Certified Healthcare Auditor (CHA) certification to be completed within one year of employment is preferred.
**Benefits**
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call or send an email to .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
**Req Number:** R-
**Job Function:** Legal and Compliance
**Featured:** No
**Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.**
**Facility:** Remote WI
**Location:** Remote, WI
**Address:**
**Shift:** 8 Hours - Day Shifts
**Job Schedule:** Full time
**Weekly Hours:** 40.00
**Salary Range:** 19.00 - 30.50
**Job Summary**
Responsible for conducting internal audits and monitors to ensure that the organization's processes and operations are in compliance with laws, corporate guidelines, best practices, and contractual agreements. Knowledgeable of general audit concepts and techniques, including the type of audits, the approaches and processes, and the subsequent activities, as they relate to internal audits. Demonstrates the ability to interpret Federal rules and regulations. Demonstrates the ability to research regulation from various data sources. Demonstrates an advanced knowledge and skill in analyzing patient records to identify non-conformances in Current Procedural Terminology (CPT), International Classification of Diseases, Tenth Edition (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) code assignment. Demonstrates both knowledge and application of Sanford Health Systems, policies, procedures, and guidelines. Demonstrates commitment to continuous learning for themselves and performs as a role model to other coding staff.
**Qualifications**
High school diploma or equivalent preferred. Advanced diploma or degree in Health Information Management or healthcare related field is preferred.
Prior relevant compliance work experience is preferable. Two years' experience is required.
Certification in one of the following is required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) or an equivalent. Certified Healthcare Auditor (CHA) certification to be completed within one year of employment is preferred.
**Benefits**
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call or send an email to .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
**Req Number:** R-
**Job Function:** Legal and Compliance
**Featured:** No
View Now
1
Nurse Compliance Auditor
90040 Los Angeles, California
Wesley Health Centers
Posted today
Job Viewed
Job Description
Position Purpose:
Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include:
Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained.
Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process.
Essential Duties and Responsibilities:
* Conduct Compliance Reviews
* Complete compliance reviews within established parameters and initiate and carry out all assigned reviews according to defined departmental policies and processes.
* Reviewing medical records and documents to abstract clinical data for HEDIS reporting.
* Integrating electronic and hardcopy data into reports.
* Preparing and presenting HEDIS compliance reports to health facility managers.
* Training and advising clinicians and care team staff on HEDIS compliance.
* Keeping abreast of HEDIS measures.
* Apply communication skills by coordinating patient services and requests, including addressing patient phone calls, telephone encounters, and patient portal queries as well as to follow up with patients after their appointments, provide appointment reminders, to follow-up on missed appointments, etc.
* Adheres to all clinic policies and procedures, as well as applicable state, federal, and other regulatory guidelines
* Maintains all necessary licensure, certification(s), including BLS. Attends annual fire and safety classes
* Attends and participates in all assigned meetings, reports, and/or committees
* Performs other duties as assigned.
Education and Qualifications
* Ex State-approved licensing and registration as a nurse (RN, LPN, or LVN)
* Current CPR (BLS) Certification
* Bilingual (in Spanish) preferred
* Extensive experience with HEDIS database entries and reporting.
* In-depth knowledge of abstracting clinical data and evaluating HEDIS compliance.
* Advanced knowledge of medical terminology, coding, and procedures.
* Extensive experience in interpreting and reporting HEDIS information, as well as training staff.
* Excellent organizational and communication skills.
* Ability to work with people of diverse cultural, educational, social, and economic backgrounds.
* Ability to work independently and a self-starter with minimal supervision
* Computer proficiency
* Experience utilizing an Electronic Medical Records (EMR) system is highly desirable
* All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.
Employee Benefits:
At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you'll enjoy competitive pay and a robust benefits package that includes:
* Medical, Dental, Vision
* Monthly employer-sponsored allowance for assistance with health premiums.
* Funded Health Savings Account (up to deductible) to assist with carrier-approved medical expenses.
* Paid time off (vacation, sick leave) and 13 paid holidays.
* 401(k) Safe Harbor Profit Sharing plan.
* Mileage reimbursement.
* Short- and long-term disability plans (LTD/STD).
* Life insurance policy & AD&D, and more!
Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.
Wesley Health Centers JWCH Institute is an Equal Opportunity Employer
Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include:
Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained.
Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process.
Essential Duties and Responsibilities:
* Conduct Compliance Reviews
* Complete compliance reviews within established parameters and initiate and carry out all assigned reviews according to defined departmental policies and processes.
* Reviewing medical records and documents to abstract clinical data for HEDIS reporting.
* Integrating electronic and hardcopy data into reports.
* Preparing and presenting HEDIS compliance reports to health facility managers.
* Training and advising clinicians and care team staff on HEDIS compliance.
* Keeping abreast of HEDIS measures.
* Apply communication skills by coordinating patient services and requests, including addressing patient phone calls, telephone encounters, and patient portal queries as well as to follow up with patients after their appointments, provide appointment reminders, to follow-up on missed appointments, etc.
* Adheres to all clinic policies and procedures, as well as applicable state, federal, and other regulatory guidelines
* Maintains all necessary licensure, certification(s), including BLS. Attends annual fire and safety classes
* Attends and participates in all assigned meetings, reports, and/or committees
* Performs other duties as assigned.
Education and Qualifications
* Ex State-approved licensing and registration as a nurse (RN, LPN, or LVN)
* Current CPR (BLS) Certification
* Bilingual (in Spanish) preferred
* Extensive experience with HEDIS database entries and reporting.
* In-depth knowledge of abstracting clinical data and evaluating HEDIS compliance.
* Advanced knowledge of medical terminology, coding, and procedures.
* Extensive experience in interpreting and reporting HEDIS information, as well as training staff.
* Excellent organizational and communication skills.
* Ability to work with people of diverse cultural, educational, social, and economic backgrounds.
* Ability to work independently and a self-starter with minimal supervision
* Computer proficiency
* Experience utilizing an Electronic Medical Records (EMR) system is highly desirable
* All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.
Employee Benefits:
At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you'll enjoy competitive pay and a robust benefits package that includes:
* Medical, Dental, Vision
* Monthly employer-sponsored allowance for assistance with health premiums.
* Funded Health Savings Account (up to deductible) to assist with carrier-approved medical expenses.
* Paid time off (vacation, sick leave) and 13 paid holidays.
* 401(k) Safe Harbor Profit Sharing plan.
* Mileage reimbursement.
* Short- and long-term disability plans (LTD/STD).
* Life insurance policy & AD&D, and more!
Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.
Wesley Health Centers JWCH Institute is an Equal Opportunity Employer
View Now
2
Nurse Compliance Auditor
90040 Los Angeles, California
JWCH Institute
Posted today
Job Viewed
Job Description
Position Purpose:
Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include:
Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained.
Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process.
Essential Duties and Responsibilities :
Education and Qualifications
*All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.
Employee Benefits:
At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you'll enjoy competitive pay and a robust benefits package that includes:
Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.
Wesley Health Centers JWCH Institute is an Equal Opportunity Employer
Under the direct supervision of the Director of Quality Assurance, the Licensed Nurse is responsible for supporting the compliance functions of the Quality Assurance and Performance Improvement department of JWCH. The responsibilities include:
Maintaining defined review schedule for JWCH agency by (1) doing preparatory work for the audit including developing a scope of work, (2) reviewing the documentation, (3) preparing reports, (4) doing any necessary follow-up reviews and (5) ensuring that appropriate collected data are securely kept and maintained.
Serve as a resource to clients in answering compliance questions from Internal Audit and Audit Advisory Services and assisting as necessary in their audit process.
Essential Duties and Responsibilities :
- Conduct Compliance Reviews
- Complete compliance reviews within established parameters and initiate and carry out all assigned reviews according to defined departmental policies and processes.
- Reviewing medical records and documents to abstract clinical data for HEDIS reporting.
- Integrating electronic and hardcopy data into reports.
- Preparing and presenting HEDIS compliance reports to health facility managers.
- Training and advising clinicians and care team staff on HEDIS compliance.
- Keeping abreast of HEDIS measures.
- Apply communication skills by coordinating patient services and requests, including addressing patient phone calls, telephone encounters, and patient portal queries as well as to follow up with patients after their appointments, provide appointment reminders, to follow-up on missed appointments, etc.
- Adheres to all clinic policies and procedures, as well as applicable state, federal, and other regulatory guidelines
- Maintains all necessary licensure, certification(s), including BLS. Attends annual fire and safety classes
- Attends and participates in all assigned meetings, reports, and/or committees
- Performs other duties as assigned.
Education and Qualifications
- Ex State-approved licensing and registration as a nurse (RN, LPN, or LVN)
- Current CPR (BLS) Certification
- Bilingual (in Spanish) preferred
- Extensive experience with HEDIS database entries and reporting.
- In-depth knowledge of abstracting clinical data and evaluating HEDIS compliance.
- Advanced knowledge of medical terminology, coding, and procedures.
- Extensive experience in interpreting and reporting HEDIS information, as well as training staff.
- Excellent organizational and communication skills.
- Ability to work with people of diverse cultural, educational, social, and economic backgrounds.
- Ability to work independently and a self-starter with minimal supervision
- Computer proficiency
- Experience utilizing an Electronic Medical Records (EMR) system is highly desirable
*All JWCH, Wesley Health Centers workforce members are recommended to be fully vaccinated against COVID-19.
Employee Benefits:
At JWCH Institute, Inc., we believe in taking care of those who take care of others. If you work 30+ hours per week, you'll enjoy competitive pay and a robust benefits package that includes:
- Medical, Dental, Vision
- Monthly employer-sponsored allowance for assistance with health premiums.
- Funded Health Savings Account (up to deductible) to assist with carrier-approved medical expenses.
- Paid time off (vacation, sick leave) and 13 paid holidays.
- 401(k) Safe Harbor Profit Sharing plan.
- Mileage reimbursement.
- Short- and long-term disability plans (LTD/STD).
- Life insurance policy & AD&D, and more!
Become part of a team where your work matters. Apply today and help us change lives, one patient at a time.
Wesley Health Centers JWCH Institute is an Equal Opportunity Employer
View Now
3
Sr. Compliance Auditor
30309 Midtown Atlanta, Georgia
Emory Healthcare/Emory University
Posted today
Job Viewed
Job Description
**Overview**
**Be inspired. Be rewarded. Belong. At Emory Healthcare.**
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources,ongoing mentorship and leadership programs for all types of jobs, and asupportive environment that enables you to reach new heights in your career
and be what you want to be. We provide:
+ Comprehensive health benefits that start day 1
+ Student Loan Repayment Assistance & Reimbursement Programs
+ Family-focused benefits
+ Wellness incentives
+ Ongoing mentorship and leadership programs
+ And more!
**Description**
Reporting to the Director, Compliance Audit and Analysis, the Sr. Compliance Auditor will develop and execute audit, monitoring, and education for both facility and professional billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluate facility/professional billing compliance activities to assess compliance with the Compliance Audit and Analysis Program Work Plan and appropriately focuses on risk areas. Serve as a resource for providers and other clinicians on facility/physician billing and coding.This individual will:
+ Prepare and oversees facility/professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
+ Lead focused audits and reviews to investigate adherence with facility/professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
+ Assist in development of organizational compliance auditing and monitoring activities for facility/professional billing and coding, including periodic reviews of the individual department auditing and monitoring functions.
+ Coordinate sample reviews to ensure codes that were billed are properly supported by appropriate documentation and creates audit result reports to be reviewed with providers and hospital departments.
+ Serve as primary lead for facility/professional billing compliance education including auditing, trending, and feedback to facility/professional coders and providers working in the hospital and office setting, as applicable.
+ Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers and leads training on proper documentation for facility/professional billing and coding compliance.
+ Work with the compliance operations, billing team, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.
+ Provide counseling, education and/or recommended disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to facility/professional billing compliance.
**MINIMUM REQUIREMENTS:**
+ Bachelors degree required,5 years of experience required or experience in lieu of degree.
+ Current Certified Coding Specialist (CCS) or Certified Professional Coder certification required.
+ Minimum of five to seven (5-7) years of experience with facility and/or professional audit activities, required.
+ Proficient in MDAudit Enterprise software and Epic electronic health record systems.
+ Thorough knowledge of coding documentation improvement practices.
+ Thorough knowledge and understanding of hospital inpatient billing, coding, and documentation requirements, Federal and State regulations, medical necessity, clinical best practices, and facility/professional billing issues.
**Additional Details**
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at . Please note that one week's advance notice is preferred.
**Connect With Us!**
Connect with us for general consideration!
**Division** _Emory Healthcare Inc._
**Campus Location** _Atlanta, GA, 30345_
**Campus Location** _US-GA-Atlanta_
**Department** _EHI Office of Compliance_
**Job Type** _Regular Full-Time_
**Job Number** _ _
**Job Category** _Business Operations_
**Schedule** _8a-4:30p_
**Standard Hours** _40 Hours_
**Hourly Minimum** _USD $44.38/Hr._
**Hourly Midpoint** _USD $54.07/Hr._
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
**Be inspired. Be rewarded. Belong. At Emory Healthcare.**
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources,ongoing mentorship and leadership programs for all types of jobs, and asupportive environment that enables you to reach new heights in your career
and be what you want to be. We provide:
+ Comprehensive health benefits that start day 1
+ Student Loan Repayment Assistance & Reimbursement Programs
+ Family-focused benefits
+ Wellness incentives
+ Ongoing mentorship and leadership programs
+ And more!
**Description**
Reporting to the Director, Compliance Audit and Analysis, the Sr. Compliance Auditor will develop and execute audit, monitoring, and education for both facility and professional billing, coding and documentation programs that ensure compliance with regulatory standards. Continuously evaluate facility/professional billing compliance activities to assess compliance with the Compliance Audit and Analysis Program Work Plan and appropriately focuses on risk areas. Serve as a resource for providers and other clinicians on facility/physician billing and coding.This individual will:
+ Prepare and oversees facility/professional billing and coding components of the Compliance work plan reflecting scheduled activities and target dates.
+ Lead focused audits and reviews to investigate adherence with facility/professional billing compliance policies, legal and regulatory requirements, and to identify and evaluate risk areas.
+ Assist in development of organizational compliance auditing and monitoring activities for facility/professional billing and coding, including periodic reviews of the individual department auditing and monitoring functions.
+ Coordinate sample reviews to ensure codes that were billed are properly supported by appropriate documentation and creates audit result reports to be reviewed with providers and hospital departments.
+ Serve as primary lead for facility/professional billing compliance education including auditing, trending, and feedback to facility/professional coders and providers working in the hospital and office setting, as applicable.
+ Manage and foster relationships with internal coders and managers and 3rd party clinical reviewers and leads training on proper documentation for facility/professional billing and coding compliance.
+ Work with the compliance operations, billing team, senior leaders, and key department stakeholders to ensure training is current, relevant, and innovative.
+ Provide counseling, education and/or recommended disciplinary action if necessary or required for non-compliance with any internal or external policies and procedures related to facility/professional billing compliance.
**MINIMUM REQUIREMENTS:**
+ Bachelors degree required,5 years of experience required or experience in lieu of degree.
+ Current Certified Coding Specialist (CCS) or Certified Professional Coder certification required.
+ Minimum of five to seven (5-7) years of experience with facility and/or professional audit activities, required.
+ Proficient in MDAudit Enterprise software and Epic electronic health record systems.
+ Thorough knowledge of coding documentation improvement practices.
+ Thorough knowledge and understanding of hospital inpatient billing, coding, and documentation requirements, Federal and State regulations, medical necessity, clinical best practices, and facility/professional billing issues.
**Additional Details**
Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare's Human Resources at . Please note that one week's advance notice is preferred.
**Connect With Us!**
Connect with us for general consideration!
**Division** _Emory Healthcare Inc._
**Campus Location** _Atlanta, GA, 30345_
**Campus Location** _US-GA-Atlanta_
**Department** _EHI Office of Compliance_
**Job Type** _Regular Full-Time_
**Job Number** _ _
**Job Category** _Business Operations_
**Schedule** _8a-4:30p_
**Standard Hours** _40 Hours_
**Hourly Minimum** _USD $44.38/Hr._
**Hourly Midpoint** _USD $54.07/Hr._
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.
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4
Lead Compliance Auditor
92108 Mission Valley, California
General Atomics
Posted 2 days ago
Job Viewed
Job Description
General Atomics (GA), and its affiliated companies, is one of the world's leading resources for high-technology systems development ranging from the nuclear fuel cycle to remotely piloted aircraft, airborne sensors, and advanced electric, electronic, wireless and laser technologies.
We have an exciting opportunity for a Lead Compliance Auditor in the Internal Audit Department. With consultative direction, this position is responsible for evaluating and investigating reported concerns to ensure compliance with regulations and the Company's policies and procedures.
**DUTIES AND RESPONSBILITIES:**
+ Thoroughly investigates reports of suspected noncompliant activity that could potentially impact financial integrity, government contracting, or regulatory compliance. Gathers and analyzes evidence to determine if violations have occurred.
+ Evaluates the Company's compliance with contractual requirements, including government procurement regulations such as FAR, DFARS, DEAR, and CAS.
+ Performs internal audits, investigations, and/or reviews or other duties as assigned or required.
+ Collaborates with data analysts to review and interpret results.
+ Identifies, documents and prepares detailed reports outlining findings, investigation results, and recommendations.
+ Reviews all draft reports prior to management review.
+ Provides guidance and support to team members.
+ Establishes and maintains effective working relationships with various departments.
+ Maintains strict confidentiality of sensitive information.
+ Responsible for observing all laws, regulations, and other applicable obligations wherever and whenever business is conducted on behalf of the Company.
We recognize and appreciate the value and contributions of individuals with diverse backgrounds and experiences and welcome all qualified individuals to apply.
50909
**Job Qualifications:**
+ Typically requires a bachelor's degree in business administration with an emphasis in accounting and/or finance and fifteen or more years of progressive accounting experience in a corporate environment, preferably with a government contractor. May substitute equivalent experience in lieu of education.
+ Demonstrated ability to organize, plan, and execute unbiased internal audits, investigations and/or reviews.
+ Demonstrates project leadership skills including organizing, scheduling, conducting, and coordinating work assignments to meet business needs.
+ Must possess strong interviewing and investigative skills.
+ Ability to manage time and priorities.
+ Ability to thoroughly complete complex and time sensitive assignments.
+ Strong knowledge of Microsoft products (Office, SharePoint, etc.).
+ Must be customer focused and possess:
+ the ability to identify issues and develop strategies to a variety of complex matters of diverse scope and nature;
+ excellent analytical, verbal and written communication skills to accurately document, report, and present findings;
+ the ability to maintain the confidentiality of sensitive information;
+ the ability to represent the department on investigations;
+ excellent computer skills.
+ Ability to work independently or in a team environment is essential as is the ability to work extended hours and travel as required.
+ Two or more years of specialized experience with Enterprise Resource Planning systems in the Aerospace and Defense industry is desirable. Experience in using the SAP costing module and its integration with other SAP modules is preferred.
+ Must be a United States citizen.
**Salary:** $105,890 - $189,545 **Travel Percentage Required** 0 - 25 **Relocation Assistance Provided** Provided **US Citizenship Required?** Yes **Clearance Required?** No **Clearance Level** Senior (8+ years) **Workstyle** Onsite
General Atomics is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity/Affirmative Action Employer and will consider all qualified applicants for employment without regard to race, color, religion, religious creed, ancestry, gender, pregnancy, sex, sexual orientation, transitioning status, gender identity, gender expression, national origin, age, genetic information, military and veteran status, marital status, medical condition, mental disability, physical disability, or any other basis protected by local, state, or federal law. EEO is the law. We also prohibit compensation discrimination under all applicable laws. To learn more visit Notices.pdf. U.S. Citizenship is required for certain positions.
We have an exciting opportunity for a Lead Compliance Auditor in the Internal Audit Department. With consultative direction, this position is responsible for evaluating and investigating reported concerns to ensure compliance with regulations and the Company's policies and procedures.
**DUTIES AND RESPONSBILITIES:**
+ Thoroughly investigates reports of suspected noncompliant activity that could potentially impact financial integrity, government contracting, or regulatory compliance. Gathers and analyzes evidence to determine if violations have occurred.
+ Evaluates the Company's compliance with contractual requirements, including government procurement regulations such as FAR, DFARS, DEAR, and CAS.
+ Performs internal audits, investigations, and/or reviews or other duties as assigned or required.
+ Collaborates with data analysts to review and interpret results.
+ Identifies, documents and prepares detailed reports outlining findings, investigation results, and recommendations.
+ Reviews all draft reports prior to management review.
+ Provides guidance and support to team members.
+ Establishes and maintains effective working relationships with various departments.
+ Maintains strict confidentiality of sensitive information.
+ Responsible for observing all laws, regulations, and other applicable obligations wherever and whenever business is conducted on behalf of the Company.
We recognize and appreciate the value and contributions of individuals with diverse backgrounds and experiences and welcome all qualified individuals to apply.
50909
**Job Qualifications:**
+ Typically requires a bachelor's degree in business administration with an emphasis in accounting and/or finance and fifteen or more years of progressive accounting experience in a corporate environment, preferably with a government contractor. May substitute equivalent experience in lieu of education.
+ Demonstrated ability to organize, plan, and execute unbiased internal audits, investigations and/or reviews.
+ Demonstrates project leadership skills including organizing, scheduling, conducting, and coordinating work assignments to meet business needs.
+ Must possess strong interviewing and investigative skills.
+ Ability to manage time and priorities.
+ Ability to thoroughly complete complex and time sensitive assignments.
+ Strong knowledge of Microsoft products (Office, SharePoint, etc.).
+ Must be customer focused and possess:
+ the ability to identify issues and develop strategies to a variety of complex matters of diverse scope and nature;
+ excellent analytical, verbal and written communication skills to accurately document, report, and present findings;
+ the ability to maintain the confidentiality of sensitive information;
+ the ability to represent the department on investigations;
+ excellent computer skills.
+ Ability to work independently or in a team environment is essential as is the ability to work extended hours and travel as required.
+ Two or more years of specialized experience with Enterprise Resource Planning systems in the Aerospace and Defense industry is desirable. Experience in using the SAP costing module and its integration with other SAP modules is preferred.
+ Must be a United States citizen.
**Salary:** $105,890 - $189,545 **Travel Percentage Required** 0 - 25 **Relocation Assistance Provided** Provided **US Citizenship Required?** Yes **Clearance Required?** No **Clearance Level** Senior (8+ years) **Workstyle** Onsite
General Atomics is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity/Affirmative Action Employer and will consider all qualified applicants for employment without regard to race, color, religion, religious creed, ancestry, gender, pregnancy, sex, sexual orientation, transitioning status, gender identity, gender expression, national origin, age, genetic information, military and veteran status, marital status, medical condition, mental disability, physical disability, or any other basis protected by local, state, or federal law. EEO is the law. We also prohibit compensation discrimination under all applicable laws. To learn more visit Notices.pdf. U.S. Citizenship is required for certain positions.
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5
Clinical Compliance Auditor
90006 Los Angeles, California
Astrix Technology
Posted 2 days ago
Job Viewed
Job Description
**Clinical Compliance Auditor**
Clinical
Los Angeles, CA, US
Pay Rate Low: | Pay Rate High:
+ Added - 04/04/2025
Apply for Job
We're partnering with an innovative client in the biotechnology industry, and they're on the lookout for a talented **Clinical Compliance Auditor** to join their dynamic team! If you're passionate about ensuring the highest standards in clinical trials and want to make a real impact, this is the opportunity for you. Don't wait-apply today and take the next step in your career
**Salary:** $100,000-$150,000
**Location:** Remote
**Responsibilities:**
+ Oversee and regularly update the Clinical Trial Quality Management system to ensure alignment with current industry standards, guidelines, and best practices.
+ Assist in the creation and evaluation of standard operating procedures (SOPs) and other essential controlled documents, such as forms, templates, and work instructions.
+ Ensure adherence to SOPs and compliance with relevant standards, including ICH GCP E6 (R2).
+ Lead the incident management process by tracking and addressing complaints, deviations, and corrective actions (CAPAs).
+ Organize, coordinate, and execute audits of vendors, suppliers, clinical trial sites, as well as internal and compliance audits, including for-cause audits.
+ Prepare necessary documentation to support audit activities, including audit plans, reports, certificates, and corrective action plans.
+ Verify the accuracy of audit findings and follow-up activities, ensuring non-compliance issues are resolved appropriately.
+ Review and finalize audit reports for accuracy and completeness.
+ Examine trial-related documents such as protocols, amendments, informed consent forms (ICFs), pharmacy manuals, and clinical study reports (CSRs).
**Requirements:**
+ Bachelor's or Master's degree in a life sciences or engineering discipline
+ 4-7 years of experience in a GCP-Biologics or pharmaceutical environment.
+ CQA or other audit certifications are desirable.
+ Previous experience with TMF or electronic document management systems is a plus.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Clinical
Los Angeles, CA, US
Pay Rate Low: | Pay Rate High:
+ Added - 04/04/2025
Apply for Job
We're partnering with an innovative client in the biotechnology industry, and they're on the lookout for a talented **Clinical Compliance Auditor** to join their dynamic team! If you're passionate about ensuring the highest standards in clinical trials and want to make a real impact, this is the opportunity for you. Don't wait-apply today and take the next step in your career
**Salary:** $100,000-$150,000
**Location:** Remote
**Responsibilities:**
+ Oversee and regularly update the Clinical Trial Quality Management system to ensure alignment with current industry standards, guidelines, and best practices.
+ Assist in the creation and evaluation of standard operating procedures (SOPs) and other essential controlled documents, such as forms, templates, and work instructions.
+ Ensure adherence to SOPs and compliance with relevant standards, including ICH GCP E6 (R2).
+ Lead the incident management process by tracking and addressing complaints, deviations, and corrective actions (CAPAs).
+ Organize, coordinate, and execute audits of vendors, suppliers, clinical trial sites, as well as internal and compliance audits, including for-cause audits.
+ Prepare necessary documentation to support audit activities, including audit plans, reports, certificates, and corrective action plans.
+ Verify the accuracy of audit findings and follow-up activities, ensuring non-compliance issues are resolved appropriately.
+ Review and finalize audit reports for accuracy and completeness.
+ Examine trial-related documents such as protocols, amendments, informed consent forms (ICFs), pharmacy manuals, and clinical study reports (CSRs).
**Requirements:**
+ Bachelor's or Master's degree in a life sciences or engineering discipline
+ 4-7 years of experience in a GCP-Biologics or pharmaceutical environment.
+ CQA or other audit certifications are desirable.
+ Previous experience with TMF or electronic document management systems is a plus.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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6
Compliance Auditor, Associate
15222 Pittsburgh, Pennsylvania
UPMC
Posted 16 days ago
Job Viewed
Job Description
**Join UPMC Corporate Finance as a Compliance Auditor, Associate!**
Are you detail-oriented and passionate about ensuring compliance in healthcare? **UPMC Corporate Finance** is looking for a dedicated and meticulous **Compliance Auditor, Associate** to join our team. This role is crucial in maintaining the integrity of our coding and billing processes, ensuring they meet state and federal regulations.
**Key Responsibilities:**
+ **Comprehensive Auditing:** Conduct UPMC-wide auditing and monitoring to ensure that coding/documentation combinations and medical record documentation adequately support services coded and billed in accordance with appropriate state and federal regulations and standards.
+ **Code Validation:** Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCD and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.
+ **Post-Audit Training:** Conduct post-audit compliance training sessions for physicians and non-physician practitioners based on audit results. These sessions will provide education specific to the issues found during audits and will be based on documentation, coding, and billing rules set forth by CMS and other relevant federal and state regulatory agencies.
+ **E/M and External Audits:** Complete Evaluation and Management (E/M) audits and external audits to ensure comprehensive compliance.
+ **Reporting Assistance:** Assist with reporting audit numbers for administration and board books, ensuring accurate and timely information is provided.
**What Sets Us Apart?**
+ **Impactful Work:** Your role will directly contribute to the accuracy and compliance of our healthcare services, ensuring we meet all regulatory standards.
+ **Professional Growth:** Gain valuable experience in auditing and compliance within a leading healthcare organization, with opportunities for career advancement.
+ **Collaborative Environment:** Work alongside a team of dedicated professionals who are committed to excellence and continuous improvement.
If you're ready to take on a challenging and rewarding role that offers significant impact and growth opportunities, we want to hear from you! Apply now and join a team that values precision, integrity, and strategic thinking.
+ High School Diploma or equivalent required.
+ Associate's degree or comparable technical school diploma is preferred.
+ 1 year of experience in medical coding, auditing, billing and compliance.
+ Knowledge of CMS and third-party payer coding, billing, and documentation compliance regulations preferred (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
+ Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.
+ Experience in an academic medical center setting is preferred.
+ Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.
+ Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.
+ Must have strong interpersonal, organizational, analytical and communication skills.
+ Ability to work in a fast-paced environment.
+ Ability to manage multiple tasks and projects.
+ Ability to forge strong interpersonal relationships within the department and with other departments. **Licensure, Certifications, and Clearances:** (Preferred)
+ Certified Coding Specialist (CCS)
+ Certified Inpatient Coder (CIC)
+ Certified Evaluation & Management Coder (CEMC)
+ Certified Professional Medical Auditor (CPMA)
+ Certified Professional Coder (CPC)
+ Certified Medical Coder (CMC)
+ Registered Health Information Administrator (RHIA)
+ Registered Health Information Technician (RHIT)
+ Licensed Professional Nurse (LPN) or
+ Registered Nurse (RN)
+ Act 34
**UPMC is an Equal Opportunity Employer/Disability/Veteran**
Are you detail-oriented and passionate about ensuring compliance in healthcare? **UPMC Corporate Finance** is looking for a dedicated and meticulous **Compliance Auditor, Associate** to join our team. This role is crucial in maintaining the integrity of our coding and billing processes, ensuring they meet state and federal regulations.
**Key Responsibilities:**
+ **Comprehensive Auditing:** Conduct UPMC-wide auditing and monitoring to ensure that coding/documentation combinations and medical record documentation adequately support services coded and billed in accordance with appropriate state and federal regulations and standards.
+ **Code Validation:** Validate the ICD-10-CM, CPT, and HCPCS codes or CPT and HCPCS ICD-10-CM-PCD and DRG assignment appropriateness to ensure consistency and efficiency in claims processing, data collection, and quality reporting.
+ **Post-Audit Training:** Conduct post-audit compliance training sessions for physicians and non-physician practitioners based on audit results. These sessions will provide education specific to the issues found during audits and will be based on documentation, coding, and billing rules set forth by CMS and other relevant federal and state regulatory agencies.
+ **E/M and External Audits:** Complete Evaluation and Management (E/M) audits and external audits to ensure comprehensive compliance.
+ **Reporting Assistance:** Assist with reporting audit numbers for administration and board books, ensuring accurate and timely information is provided.
**What Sets Us Apart?**
+ **Impactful Work:** Your role will directly contribute to the accuracy and compliance of our healthcare services, ensuring we meet all regulatory standards.
+ **Professional Growth:** Gain valuable experience in auditing and compliance within a leading healthcare organization, with opportunities for career advancement.
+ **Collaborative Environment:** Work alongside a team of dedicated professionals who are committed to excellence and continuous improvement.
If you're ready to take on a challenging and rewarding role that offers significant impact and growth opportunities, we want to hear from you! Apply now and join a team that values precision, integrity, and strategic thinking.
+ High School Diploma or equivalent required.
+ Associate's degree or comparable technical school diploma is preferred.
+ 1 year of experience in medical coding, auditing, billing and compliance.
+ Knowledge of CMS and third-party payer coding, billing, and documentation compliance regulations preferred (MS-DRG, APR-DRG, APC, APG or ICD10-CM, HCPCS, CPT, Modifiers, etc.).
+ Knowledge of coding/classification systems appropriate for inpatient /outpatient, DRG prospective payment system or office setting E/M codes.
+ Experience in an academic medical center setting is preferred.
+ Proficiency with associated technology solutions such as Microsoft Excel, Word and PowerPoint is strongly preferred.
+ Must be able to demonstrate a high degree of professionalism, enthusiasm and initiative daily.
+ Must have strong interpersonal, organizational, analytical and communication skills.
+ Ability to work in a fast-paced environment.
+ Ability to manage multiple tasks and projects.
+ Ability to forge strong interpersonal relationships within the department and with other departments. **Licensure, Certifications, and Clearances:** (Preferred)
+ Certified Coding Specialist (CCS)
+ Certified Inpatient Coder (CIC)
+ Certified Evaluation & Management Coder (CEMC)
+ Certified Professional Medical Auditor (CPMA)
+ Certified Professional Coder (CPC)
+ Certified Medical Coder (CMC)
+ Registered Health Information Administrator (RHIA)
+ Registered Health Information Technician (RHIT)
+ Licensed Professional Nurse (LPN) or
+ Registered Nurse (RN)
+ Act 34
**UPMC is an Equal Opportunity Employer/Disability/Veteran**
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7
Clinical Compliance Auditor
Atlanta, Georgia
NANA Healthcare Management, LLC
Posted today
Job Viewed
Job Description
Job Description
Job Description
NANA Healthcare Management manages multiple behavioral health and detoxification treatment centers within the behavioral health industry. With a focus on evidence-based, client-centered treatment programs that offer clients with all levels of need therapeutic interventions in a warm, welcoming environment, NANA Healthcare Management aims to provide clients with care that meets them where they are at and helps them "Be the great person they were always meant to be."
NANA Healthcare Management is seeking a Compliance Manager to promote quality documentation practices and ensure regulatory readiness across all facilities in a behavioral health setting.
Schedule: 8:30am-5:00pm
Pay: $60,000 - $65,000 annually
Type: Full-time
The Clinical Compliance Auditor is responsible for conducting clinical documentation audits across all NANA Healthcare Management facilities. This includes evaluating the quality, accuracy, and timeliness of documentation for compliance with Georgia DCH, DBHDD, Joint Commission, and insurance requirements.
Knowledge and Training:
- Adhere to Confidentiality requirements as outlined in 42 CFR, Part 2.
- Must have the ability to interact with staff in a professional manner.
- The ability to handle stressful and demanding situations
- Knowledge of Medicaid, DBHDD, DCH, and Joint Commission documentation standards.
- Strong attention to detail, time management, and interpersonal skills.
- Ability to conduct objective chart reviews and summarize findings.
- Understanding of medical necessities, assessments, and treatment planning documentation.
- Familiarity with trauma-informed care, ASAM criteria, and progress note auditing.
- Experience using EHR systems such as Kipu, EPIC, Carelogic, or similar.
- Perform routine chart audits across levels of care (residential, PHP, IOP, outpatient).
- Evaluate assessments, treatment plans, progress notes, and discharges for quality and completeness.
- Ensure documentation meets standards for medical necessity and clinical best practice.
- Identify deficiencies and generate audit findings reports.
- Collaborate with Compliance Manager and Clinical Directors on corrective actions.
- Assist in Root Cause Analysis for documentation-related incidents.
- Maintain audit logs and tracking systems.
- Participate in compliance training development and delivery.
- Support internal mock surveys and payer audit preparation.
- Work with the compliance team to ensure audit findings are addressed in a timely manner.
- Master’s degree in Social Work, Counseling, or related field
- 2+ years of experience in a behavioral health setting
- LCSW, LPC, LMSW, LMFT in Georgia
- Paid time off
- Paid Holidays
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Team-oriented work environment
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8
Clinical Compliance Auditor
84025 Dutch John, Utah
PACS
Posted 2 days ago
Job Viewed
Job Description
General Purpose
Join us at PACS and take advantage of a workplace that truly values you!
The Clinical Compliance Auditor is responsible for performing clinical compliance audits on facility medical records and billing information to ensure accuracy and compliance with regulations. This role also involves participating in investigations and ethics response, as well as providing education, training, and enforcement, as requested. The Clinical Audit Team will be comprised of therapists, nurses, medical records specialists and billing and coding specialists.
Essential Duties
- Conduct clinical compliance audits on facility medical records and billing information to ensure accuracy and adherence to regulatory coding and billing standards.
- Identify areas of non-compliance and recommend corrective actions.
- Participate in internal investigations and ethics hot line response, as requested, including reviewing complaints, conducting investigations, assigning follow-up actions, and confirming recommended remedial action occurs.
- Assist in the development and delivery of targeted educational materials and training programs to relevant Regional and facility staff on proper coding procedures and documentation requirements .
- Collaborate with the Regulatory Policy & Standards team to stay updated on state and federal regulations, coding guidelines and payor guidance.
- Contribute to the Compliance Newsletter and Communications to keep staff informed about compliance updates and best practices.
- Assist in Triple Check development, training and enhancements to improve compliance and accuracy in billing and coding practices.
Qualifications
- Masters or Doctorate in Speech-Language Pathology; Licensed Physical Therapist; Registered Nurse or Licensed Practical Nurse; or Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
- Minimum of 3 years of experience in clinical billing and coding compliance auditing.
- Medical Records background and solid understanding of ICD-10 coding guidelines is preferred.
- Strong knowledge of state and federal regulations related to healthcare billing and coding.
- Excellent analytical and problem-solving skills.
- Strong communication and interpersonal skills.
- Ability to work independently and as part of a team.
- Detail-oriented with a high level of accuracy.
Join PACS: Elevate Healthcare with Us!
PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment , we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.
If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let's shape the future of healthcare!
Join Our Team and Thrive!
At PACS, we believe our employees are our greatest asset. That's why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.
Our Comprehensive Benefits Include
- Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.
- PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.
- Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
- Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
- Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.
Join us at PACS and take advantage of a workplace that truly values you!
Apply Now
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