Central Health · 3 months ago
Healthcare Delivery Auditor
Austin, TX
Full-time
Onsite
Mid Level
3+ years expCentral Health is dedicated to providing access to high-quality care for underserved populations. The Healthcare Delivery Auditor conducts internal audits of healthcare delivery programs and clinical services, focusing on compliance, operational workflows, and the effectiveness of internal controls.
Health CareHealth DiagnosticsMedical
Responsibilities
Conducts risk-based audits of healthcare delivery and clinical operations, including patient chart reviews, referral processes, and encounter documentation
Conducts detailed audits including data collection, analysis, and testing of internal controls
Assesses compliance with federal and state healthcare regulations, Central Health policies, and contractual obligations with delivery system partners
Evaluates the effectiveness and efficiency of operations and compliance with applicable laws and regulations
Documents audit findings, prepares workpapers, and ensures proper evidence is maintained
Drafts clear and concise audit reports summarizing findings, conclusions, and recommendations
Monitors changes in laws, regulations, and industry standards
Performs risk assessments to identify areas of potential vulnerability and risk
Assists in the development and implementation of risk management strategies
Recommends improvements to policies, procedures, and systems to enhance internal controls
Remains up to date on best practices in audit and internal controls
Preforms other duties as assigned
Qualification
Required
Bachelor's Degree (higher degree accepted) in Healthcare Administration, Public Health, Nursing, Business, or a related field
3 years Experience in healthcare auditing, chart review, or compliance in a clinical or managed care setting
Extensive understanding of healthcare laws, regulations, and standards such as HIPAA, OSHA, The Joint Commission (TJC), and local/state regulations
Working knowledge of healthcare regulations (e.g., CMS, Medicaid, HIPAA), documentation standards, and billing requirements
Knowledge of patient safety standards and quality improvement protocols
Familiarity with the principles of risk management, including risk identification, assessment, mitigation, and monitoring
Understanding of risk management frameworks and methodologies, such as Failure Mode and Effects Analysis (FMEA) and Root Cause Analysis (RCA)
In-depth knowledge of clinical workflows and healthcare operations, including patient care processes, medical documentation, and healthcare technologies
Awareness of potential risks inherent in clinical practices, such as medication errors, infection control breaches, and patient safety issues
Understanding of crisis management strategies and emergency preparedness planning
Knowledge of disaster recovery and business continuity planning in a healthcare context
Knowledge of data collection, analysis, and interpretation techniques relevant to risk management
Familiarity with healthcare data systems and software used for tracking incidents, compliance, and performance metrics
Ability to analyze complex situations, identify risks, and evaluate potential impacts
Proficiency in conducting root cause analyses, developing risk assessments, and recommending corrective actions
Strong analytical, organizational, and communication skills, with the ability to interpret clinical data and regulatory criteria
Strong verbal and written communication skills for effectively conveying risk management information to diverse audiences, including healthcare staff, management, and external regulators
Ability to present findings, reports, and recommendations clearly and persuasively
Ability to lead risk management initiatives and work collaboratively with interdisciplinary teams
Skilled in fostering a culture of safety and encouraging proactive risk management practices across the organization
Proficiency in managing multiple projects simultaneously, including the ability to plan, execute, and oversee risk management projects from start to finish
Skills in prioritizing tasks, managing time effectively, and meeting deadlines
Ability to identify problems, generate solutions, and implement effective strategies to mitigate risks
Creative thinking to develop innovative approaches to risk reduction and quality improvement
Expertise in designing and delivering risk management training programs for healthcare staff
Skills in assessing training needs, developing curriculum, and evaluating the effectiveness of training initiatives
Ability to notice and address small details that could lead to larger risks or compliance issues
Meticulous approach to reviewing processes, policies, and incidents to ensure thorough risk management
Ability to make informed, timely decisions in high-pressure situations, balancing risk with the organization's needs and ethical considerations
Capability to assess various options and choose the best course of action in uncertain circumstances
Ability to adapt to changing regulations, technologies, and healthcare practices
Flexibility to respond to emerging risks and adjust risk management strategies as needed
Strong sense of ethics, with the ability to apply ethical principles to risk management decisions
Ability to maintain objectivity and integrity when dealing with sensitive issues and conflicts of interest
Ability to build and maintain effective working relationships with colleagues, stakeholders, and external partners
Skills in negotiating, influencing, and resolving conflicts constructively
Preferred
Certified Internal Auditor (CIA) Upon Hire Preferred
Certified Professional Medical Auditor (CPMA), or related certification preferred Upon Hire Preferred
Company
Central Health
Central Health is a health care company provides access to healthcare services to eligible residents of Travis County.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Jonathan Morgan
Chief Operating Officer
Alan Schalscha
Chief Medical Officer
Recent News
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