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St. Croix Hospice · 1 week ago

Compliance Auditor (Clinical)

Mendota Heights, MN

Full-time

Onsite

Entry, Mid Level

$90K/yr - $110K/yr

2+ years exp

St. Croix Hospice is dedicated to guiding patients and families through the end-of-life journey with compassionate care. The Compliance Auditor is responsible for developing and implementing compliance audit programs, ensuring adherence to regulations, and mitigating risks while collaborating with various departments to strengthen internal controls.

Health Care

Responsibilities

Assist with the development and implementation of a comprehensive compliance audit program tailored to meet the requirements of CMS, Medicaid, Medicare, Medicare Advantage plans, other government payors, private insurers, the Office of Inspector General (OIG) and the Department of Justice (DOJ)

Develop audit frameworks, methodologies and policies that align with regulatory requirements and best practices within healthcare

Ensure audits are thoroughly documented and findings are reported with corrective action recommendations

Assist with the establishment of a continuous monitoring system for compliance risks and policy effectiveness

Assist with enterprise-wide risk assessments to identify gaps with federal and state laws and regulations and internal policies

Conduct risk-based audits to assess the effectiveness of internal controls and adherence to internal policies

Develop risk mitigation strategies and ensure corrective action plans are implemented

Collaborate with departments such as Legal, Human Resources, Finance, IT, Quality, Billing and Coding to enhance internal controls and address and remediate compliance risks

Provide guidance to operational teams on improving processes to ensure compliance with federal and state laws and regulations and internal policies

Monitor emerging regulatory trends and enforcement actions to proactively address potential risks

Draft and update audit related policies, procedures and guidelines

Provide guidance on internal controls, regulatory requirements and audit best practices

Develop and deliver compliance audit training and education to employees on regulatory requirements, compliance best practices and audit procedures

Oversee internal investigations related to risk assessment and/or audit findings, conducting root cause analysis to identify trends or patterns of non-compliance

Develop corrective action plans (CAPs) and track their implementation

Ensure confidentiality and integrity in all investigations and reporting

Work closely with Legal, Human Resources and Risk Management teams to conduct investigations and recommend disciplinary action, as applicable

Ensure compliance with relevant federal and state regulations including, but not limited to, HIPAA, Stark Law, Anti-Kickback Statute, OIG Guidelines, CMS, OSHA and DOJ

Oversee regulatory reporting requirements and respond to inquiries from auditors, regulators and enforcement agencies, collaborating with St. Croix Hospice leadership and General Counsel

Prepare audit reports, present findings and recommended corrective actions to executive leadership, the Compliance Committee and the board of directors

Serve as a trusted advisor to the Chief Compliance Officer, executive team and leadership

Foster a culture of compliant and ethical behavior across the organization

Collaborate with key stakeholders

Support external auditors and regulatory agencies during compliance reviews and investigations

Qualification

Compliance AuditingRisk AssessmentHealthcare RegulationsAudit MethodologiesInternal ControlsCorrective Action PlansHealthcare Compliance CertificationsAnalytical SkillsCommunication SkillsCollaboration Skills

Required

2+ years of compliance auditing, internal audit or regulatory compliance experience

Extensive knowledge of audit methodologies, internal controls and risk assessments

Strong understanding of healthcare fraud, waste, and abuse prevention, coding compliance, and billing practices within the context of hospice care

Experience in healthcare, finance, billing, coding, compliance and government regulations

Ability to build relationships with internal and external stakeholders, including leadership, clinical teams, providers, payers, and regulatory bodies

At least one of the preferred certifications or the ability to obtain certification within 1 year of employment is required

Experience working collaboratively with regulatory agencies, auditors, and healthcare providers to ensure compliance with hospice requirements

Strong analytical and problem-solving skills, with the ability to identify compliance risks, assess organizational performance, and develop actionable solutions

Ability to pass DHS background study

Preferred

Associate's degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field

Excellent verbal and written communication skills with the ability to clearly communicate complex compliance issues to senior executives and staff members at all levels

Preferred Certifications: Certified in Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Billing and Coding Specialist (CBCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Compliance and Ethics Professional (CCEP)