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Compliance Audit Manager

Company: Hyrandes
Location: Waukegan
Posted on: November 22, 2021

Job Description:

Reporting to the Director, Compliance & Privacy, the Compliance Audit Manager is responsible for auditing and analyzing the clinical and operational work processes, policies and procedures to ensure compliance with all laws, regulations and guidelines with Federal and State programs. Develops and executes monitoring and auditing projects, to include standard, repeatable processes identifying, documenting and presenting any errors, irregularities or findings. Manages audit activity to include gathering documents and data, determining and writing reports of audit findings, identification and completion of necessary corrective action. Partners with functional leaders and field teams to coordinate audit and monitoring activities from initiation through completion of corrective action. Serves as the auditor-in-charge when necessary. Serves as a resource both internally and externally regarding compliance-related issues, including the coordination of payer, regulatory or other audits.

Job Description

Develops and executes internal monitoring and auditing activities in response to company risks in partnership with team members and leaders in other functional departments and geographic locations across the company; to include process documents, roll-out training and communications to launch audits, status updates to audit participants and relevant leaders, written report and presentation of findings, development and execution of corrective action plans and progress reports on responsive measures, and other associated activities as needed to successfully conclude audit and monitoring activities. Respects and maintains the confidentiality of sensitive business and patient information at all times. Maintains files and work papers consistent with company policy and Compliance Department processes at all times.

Coordinates with company locations and respective leadership and team members for responsive information, review of findings and determination of appeal and appropriate corrective action; ensures corrective action implementation prevents repeat claim denials; creates and presents reports on audit findings to department and senior leadership.

Manages and partners with external consultants engaged to conduct compliance audits and related activities to support successful completion of such initiatives. Coordinates with external auditors and company locations/departments under review to foster understanding and provide required documentation, correspondence, responses, appeal information or other necessary follow up as needed related to the audit process within deadlines.

Escalates and reports serious compliance, quality or other business risks timely to the Chief Compliance Officer and other functional leadership by demonstrating the ability to exercise good independent judgment in assessing the significance and relevance of identified issues. Prepares clear, accurate and timely audit reports and ensure that audit work meets internal auditing standards.

Reports and presents major deficiencies and other findings to executive management, functional leaders and organizational committees.

Develops and implements action plans, follow up schedule and reports in coordination with respective department leads

Identifies policy, procedure, and process gaps and partners with functional leaders to develop responsive corrective measures to prevent reoccurrences.

Develops and revises compliance policy and procedures related to auditing and monitoring activities.

Assists with the development and implementation of compliance training programs.

Develops and manages strong working relationships with other team members and leaders within company departments and locations.

Other duties as assigned to support Compliance Department and/or company business.

Requirements

Bachelors degree in business or a healthcare related field.

Certified Healthcare Compliance (CHC) or other related license/certification is preferred

Minimum of three years of compliance auditing in healthcare environment, preferably in home infusion/home health setting.

Qualifications

Demonstrated effective communication, presentation, organizational, and writing skills with strong attention to detail Strong computer skills, including proficiency in Microsoft Office Suite applications

Working knowledge and understanding of federal and state healthcare regulations

Skilled in problem solving and critical analysis

Skilled in developing and delivering presentations

Keywords: Hyrandes, Waukegan , Compliance Audit Manager, Accounting, Auditing , Waukegan, Illinois

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