JOB PURPOSE:

The Compliance Auditor will foster an environment that enhances and promotes compliance and adherence to all relevant federal, state, and local laws, rules, and regulations applicable to PACE, Part D, LHCSA, and Article 28 requirements, etc., through audits. The Compliance Auditor is responsible for performing internal and external auditing functions for the Compliance Department of CenterLight.

JOB RESPONSIBILITIES:

The Compliance Auditor utilizes regulatory expertise to conduct effective risk assessments and assist in preparing an annual audit plan.

• Develop comprehensive audit programs to address risks and evaluate compliance with governmental or other regulatory requirements.
• Assess control weaknesses by conducting independent audits according to the annual audit plan and develop appropriate documentation to support audit work performed.
• Use information effectively to support a viable position.
• Make self-available to help others solve problems.
• Measure and track results of audits performed through action plan follow-up.
• Maintain current knowledge base of governmental and regulatory requirements and provide education to management and governance as needed concerning organization risks and their potential impact.

• Perform other duties as required, consistent with the goals, objectives, and responsibilities of the Compliance department.

QUALIFICATIONS: 

Education: Bachelor’s degree in business, finance, health care operations, or a clinical field required.

Experience:

• Minimum of three (3) years of Healthcare Audit background preferably in a Health Insurance Plan

• Understanding of Medicare and Medicaid programs is strongly preferred.  
• An in-depth understanding of the industry's rules, guidelines, and regulations.
• Billing and Coding experience, preferred.
• Strong attention to detail, and analytical, and statistical skills.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-related qualifications and applicable employment laws.