Compliance and Audit Manager

Position Summary

The Compliance and Audit Manager establishes, implements and maintains an effective compliance program to prevent illegal, unethical or improper conduct.  The Compliance and Audit Manager conducts all internal and external audits and ensures compliance with regulatory, contractual and internal controls. The Compliance and Audit Manager is responsible for performing risk assessment for the company while understanding laws and regulations.

Duties and Responsibilities

  • Develop, implement, maintain and oversee organizational and regulatory compliance policies and procedures.
  • Respond to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.
  • Work with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.
  • Coordinate and conduct Health Plan audits by preparing audit documentation to present to the auditors and document audit tests and findings to then establish and implement policies and mediate risks.
  • Analyze and validate records, reports, operating policies and procedures, and Health Plan requirements to identify potential areas of compliance vulnerability and risk; develop/implement corrective action plans for resolution of problematic issues and provide general guidance on how to avoid or deal with similar situations in the future.
  • Institute and maintain an effective compliance communication program for the organization, including maintaining and promoting (a) use of the Compliance Hotline; (b) heightened awareness of standards of conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
  • Consult with General Counsel to resolve difficult legal compliance issues.

Knowledge

  • Bachelors Degree
  • A minimum of five years’ experience in healthcare.
  • Familiarity with operational, financial, quality assurance, and human resource procedures and regulations
  • Healthcare Compliance Certification (CHC) preferred

Skills

  • Knowledge of Microsoft Office Suite
  • Audit, Quality Management, Reporting Research Results, Analyzing Information

Abilities

  • Analytical Thinker
  • Project Management
  • Public Speaking
  • Customer Service
  • Detail-Oriented

Physical Demands

The physical demands described here are representative of those that must be met by the employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; reach with hands and arms and talk and hear.  The employee is occasionally required to stand; walk and stoop, kneel or crouch.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Position Type/ Expected Hours of Work

This is a full-time position.  Days and hours of work are Monday through Friday general time span: 7:00 a.m. to 6:00 p.m. Occasional evening and weekend work may be required as job duties demand.

Work Environment

This job operates in a clerical office setting.  This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.  The work environment characteristics described here are representative of those encountered while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Travel

This position requires up to 25% travel.

Other Duties

Please note this job description is not designated to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.  Duties, responsibilities and activities may change at any time with or without notice.

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