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Guthrie · 1 week ago

Compliance Examiner & Auditor - Integrity & Compliance Program - Full Time (Remote)

United States

Full-time

Remote

Mid, Senior Level

2+ years exp

Guthrie is a healthcare organization seeking a Healthcare Compliance Analyst & Examiner responsible for ensuring adherence to healthcare regulations and internal policies. The role involves conducting audits, risk assessments, and providing training to foster a culture of compliance across the organization.

Health CareHospitalPersonal Health

Growth Opportunities

Responsibilities

Monitor and interpret changes in healthcare laws and regulations (e.g., CMS, Stark Law, Anti-Kickback Statute, ACA, state-specific requirements)

Develop, implement, and maintain compliance policies, procedures, for the audit program

Conduct regular audits and reviews of medical records, billing, coding, provider activity, and departmental processes to ensure compliance with regulatory standards

Perform risk assessments to identify areas of vulnerability and recommend corrective actions

Investigate compliance billing-related incidents and ensuring proper documentation and reporting to authorities

Responsible for the daily management of compliance auditors

Support responses to external audits and inspections

Analyze data to detect patterns, trends, and anomalies that may indicate compliance issues

Prepare comprehensive reports on compliance activities, findings, and outcomes for management and regulatory bodies

Maintain documentation of all compliance activities, methodologies, results, and corrective actions

Develop and deliver compliance training programs for employees at all levels

Create educational materials and resources to support ongoing compliance education

Stay current with industry best practices, regulatory updates, and emerging technologies (e.g., AI, data analytics platforms)

Work closely with Compliance Officers, legal counsel, IT, clinical teams, and external partners

Present findings and recommendations to senior management, committees, and other stakeholders

Foster a culture of transparency, ethical conduct, and continuous improvement

Integrate lessons learned from internal and external compliance issues into training and program development

Leverage data analytics tools (e.g., Power BI, Tableau) and EHR systems (e.g., EPIC) to enhance compliance operations

Monitor and test the effectiveness of compliance programs and technologies, ensuring alignment with organizational values and regulatory requirements

Conduct concurrent, prospective, and retrospective audits of medical records, and billing, provider activity

Coordinate compliance-related audits, including governmental audits and appeals

Communicate audit results and corrective actions to all relevant parties

Research legislation, standards, and policies; provide analysis and recommendations

Develop and manage audit workplans and strategies

Maintain documentation and support training initiatives

Coordinate with internal/external auditors and legal counsel

Present audit findings to management and committees

Maintain professional and technical job knowledge through ongoing education and participation in professional organizations

Create and maintain KPI dashboards and compliance workplans

Direct responsibility for completion of compliance audit workplan items

Qualification

Healthcare compliance certificationData analysisRegulatory compliance knowledgeEHR systems e.g.EHR systems EPICData analytics platformsMicrosoft Office SuiteAnalytical skillsDiscretionOrganizational skillsProblem-solving skillsCommunication skillsTeam collaborationConfidentiality