Healthcare Delivery Auditor

Overview

The Healthcare Delivery Auditor supports Central Health’s mission to provide access to high-quality care for underserved populations by conducting internal audits of healthcare delivery programs and clinical services. This position is responsible for evaluating the effectiveness of internal controls, operational workflows, and compliance with applicable regulations, with a focus on chart audits, service documentation, provider billing practices, and care coordination processes.

The Auditor plans and performs audits across Central Health’s healthcare network, which includes contracted providers, clinical affiliates, and internal health system operations. This includes reviewing medical records (chart audits) to ensure documentation supports medical necessity, aligns with billing claims, and meets regulatory and policy standards (e.g., HIPAA, CMS, Texas Medicaid, and other applicable guidelines).

• Conducts risk-based audits of healthcare delivery and clinical operations, including patient chart reviews, referral processes, and encounter documentation.
• Conducts detailed audits including data collection, analysis, and testing of internal controls.
• Assesses compliance with federal and state healthcare regulations, Central Health policies, and contractual obligations with delivery system partners.
• Evaluates the effectiveness and efficiency of operations and compliance with applicable laws and regulations.
• Documents audit findings, prepares work papers, and ensures proper evidence is maintained.
• Drafts clear and concise audit reports summarizing findings, conclusions, and recommendations.
• Monitors changes in laws, regulations, and industry standards.
• Performs risk assessments to identify areas of potential vulnerability and risk.
• Assists in the development and implementation of risk management strategies.
• Recommends improvements to policies, procedures, and systems to enhance internal controls.
• Remains up to date on best practices in audit and internal controls.
• Preforms other duties as assigned.

• Extensive understanding of healthcare laws, regulations, and standards such as HIPAA, OSHA, The Joint Commission (TJC), and local/state regulations.
• Working knowledge of healthcare regulations (e.g., CMS, Medicaid, HIPAA), documentation standards, and billing requirements.
• Knowledge of patient safety standards and quality improvement protocols.

• Familiarity with the principles of risk management, including risk identification, assessment, mitigation, and monitoring.
• Understanding of risk management frameworks and methodologies, such as Failure Mode and Effects Analysis (FMEA) and Root Cause Analysis (RCA).

• In-depth knowledge of clinical workflows and healthcare operations, including patient care processes, medical documentation, and healthcare technologies.
• Awareness of potential risks inherent in clinical practices, such as medication errors, infection control breaches, and patient safety issues.

• Understanding of crisis management strategies and emergency preparedness planning.
• Knowledge of disaster recovery and business continuity planning in a healthcare context.

• Knowledge of data collection, analysis, and interpretation techniques relevant to risk management.
• Familiarity with healthcare data systems and software used for tracking incidents, compliance, and performance metrics.

• Ability to analyze complex situations, identify risks, and evaluate potential impacts.
• Proficiency in conducting root cause analyses, developing risk assessments, and recommending corrective actions.
• Strong analytical, organizational, and communication skills, with the ability to interpret clinical data and regulatory criteria.

• Strong verbal and written communication skills for effectively conveying risk management information to diverse audiences, including healthcare staff, management, and external regulators.
• Ability to present findings, reports, and…