Director, Compliance Auditor

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    "url": "https://non-clinical-emory.icims.com/jobs/166066/director%2c-compliance-auditor/job",
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    "title": "Director, Compliance Auditor",
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    "datePosted": "2024-06-04T14:10:24.995Z",
    "description": "<h2>Overview</h2>\n<p><strong>Be inspired.  Be rewarded. Belong. At Emory Healthcare.</strong> </p>\n<p>At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be.  We provide: </p>\n<ul>\n <li>Comprehensive health benefits that start day 1 </li>\n <li>Student Loan Repayment Assistance & Reimbursement Programs </li>\n <li>Family-focused benefits  </li>\n <li>Wellness incentives </li>\n <li>Ongoing mentorship, <em>development, </em>and leadership programs  </li>\n <li>And more  </li>\n</ul>\n<p><strong>Work Location: </strong>Atlanta, GA </p>\n<h2>Description</h2>\n<p>The Director, Compliance Auditor - Healthcare Provider provides expert leadership in evaluating and strengthening the organization's compliance program across clinical, billing, privacy, and operational domains.</p>\n<p> </p>\n<p>This role leads complex, risk-based compliance audits to ensure adherence to federal and state healthcare regulations and guidance from Healthcare Compliance Association, HHS-OIG, CMS, and other regulatory agencies.</p>\n<p> </p>\n<p>The position serves as a strategic advisor to executive leadership, clinical leaders, and the Compliance Committee.</p>\n<p> </p>\n<p><strong>Strategic & Leadership</strong></p>\n<li>Lead the development and execution of the annual healthcare compliance audit and monitoring plan based on enterprise risk assessments</li>\n<li>Advise the Chief Compliance Officer, Compliance Committee, and executive leadership on regulatory risk exposure, audit findings, and remediation priorities</li>\n<li>Provide mentorship and technical oversight to compliance auditors, analysts, or coders, as applicable </li>\n<li>Prepare and present executive and Board-level audit reports and trend analyses</li>\n<p><strong>Healthcare Compliance Auditing</strong></p>\n<li>Lead and perform audits to assess the design and effectiveness of internal controls, policies, and compliance safeguards in high-risk areas identified in the risk assessment </li>\n<li>Identify root causes, systemic risks, and potential overpayment exposure</li>\n<li>Ensure audit workpapers meet legal defensibility and regulatory standards</li>\n<p><strong> Regulatory & Enforcement Support</strong></p>\n<li>Support internal investigations related to potential fraud, waste, abuse, or regulatory noncompliance </li>\n<li>Assist with government audits, payer audits, RAC audits, and regulatory examinations</li>\n<li>Support overpayment identification, quantification, and repayment in coordination with Legal and Finance</li>\n<p><strong>Corrective Action & Continuous Improvement</strong></p>\n<li>Oversee development and implementation of corrective action plans (CAPs)</li>\n<li>Validate remediation through follow-up audits and ongoing monitoring</li>\n<li>Enhance continuous monitoring tools, dashboards, and audit methodologies</li>\n<li>Partner with operational leaders to improve documentation, controls, and compliance culture</li>\n<p>Additional Duties as Assigned</p>\n<p>Travel: Travel to Emory Affiliated locations as required</p>\n<p>Work Type: Hybrid employee - splits time between working remotely and working in the office</p>\n<p> </p>\n<p><strong>Minimum Qualifications</strong></p>\n<ul>\n <li>Bachelor's degree in Healthcare Administration, Nursing, Health Information Management, Accounting, Finance, or related field</li>\n <li>7 years of progressive experience in healthcare compliance auditing, internal audit, or regulatory compliance</li>\n</ul>\n<p>Knowledge, Skills & Abilities (required):</p>\n<li>Medicare and Medicaid billing rules </li>\n<li>Clinical documentation and coding standards</li>\n<li>HIPAA Privacy and Security Rules </li>\n<li>Physician compensation and contracting requirements </li>\n<li>Proven experience conducting risk-based compliance audits in a provider environment</li>\n<li>Excellent ability to communicate complex compliance issues to clinical leaders and executives</li>\n<p>Competencies:</p>\n<li>Deep healthcare regulatory expertise</li>\n<li>Clinical and operational acumen</li>\n<li>Executive presence and judgment</li>\n<li>Independence and objectivity</li>\n<li>Advanced analytical and investigative skills</li>\n<li>Ability to influence clinicians and administrators</li>\n<p>Preferred Qualifications</p>\n<ul>\n <li>Education: Master's degree (MHA, MBA, MSN, JD, or related)</li>\n <li>Experience: in hospital systems, academic medical centers, or multi-site provider organizations</li>\n <li>Familiarity with EHR systems, revenue cycle workflows, and clinical operations</li>\n <li>Experience supporting OIG audits, DOJ inquiries, CMS surveys, or payer investigations</li>\n <li>Certification: Professional certifications strongly preferred: 1. CHC, CHPC, CHC-F 2. CIA, CPA, CFE 3. RHIA, RHIT, CCS, CPC</li>\n <li>Reporting Relationship: Reports to the Chief Compliance Officer or VP, Compliance & Integrity</li>\n</ul>\n<p>PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.</p>\n<h2>Additional Details</h2>\n<p>Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.</p>\n<p> </p>\n<p>Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact Emory Healthcare’s Human Resources at [email protected]. Please note that one week's advance notice is preferred.</p>",
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