Compliance Auditor

The Compliance Auditor is responsible for developing and managing an annual audit plan based on measured risk assessments. This individual will complete compliance audits which includes Developing audit tools and methodologies, conducting entrance conference to explain the audit purpose, scope, and applicable laws/standards. It also includes obtaining the necessary information and data to conduct the audit, including reviewing records and reports.

Analyzing the information to determine if it meets the standard and drafting detailed written reports that explain the standards and the audit findings. Including recommendations of corrective action and continued monitoring and presenting the findings/recommendations at an exit conference.

Successful Candidate will have:

• Identify applicable laws, standards, and program requirements, including Department of Mental Health licensure and certificationrequirements, Health Resources and Service Administration (HRSA) requirements, and The Joint Commission’s National Patient Safety Goals and accreditation standards, Fraud Waste and Abuse laws, and appropriate Coding and Billing.
• Lead specific internal audits of internal business units to investigate adherence with policies, procedures, and regulatory requirements. This includes thoroughly researching regulations, standards, and policies and then reviewing records, reports,and other relevant sources of information to measure business compliance. Assess level of risk associated with noncompliance and provide detailed written reports, tools, data, and education.
• Assist in the development of action plans and monitor progress on such action plans that result from internal audits or external audits, certification, and accreditation surveys.
• Develop, annually, a compliance audit schedule delineating the priority areas for review based on level of risk. The level of risk should be based on completed risk assessments and audits. Work to the annual work plan and manage resources such that the work plan is completed in a timely manner.
• Assist in the development of the annual risk assessment, and coordinate with business leaders to conduct questionnaires, analyze results and ultimately assess risk.
• Serve as a resource to the Director of Compliance and external auditors during site surveys and fulfill all documentation requests.
• Conduct root cause and failure mode analysis.
• Assist in the development and revision of policies and procedures that will result in compliance.
• Assist in monitoring the implementation of best clinical practice guidelines and evidence-based practices.
• Perform other duties as assigned.

Education/Qualifications

• A Master’s degree in Business Administration, Health Administration, or closely related areas. Related training and education beyond a Bachelor’s degree may be substituted.
• Three years of experience and skill in research, auditing, and development of reports to support compliance activities.
• Strong research, writing, and report generating skills
• Experience utilizing Electronic Health Records/Electronic Medical Records.
• Working knowledge of the Missouri Code of State regulations, Joint Commission Standards, Health Resources & Services Administration (HRSA) requirements, and Health Insurance Portability and Accountability Act (HIPAA) regulations.

About Swope Health Services:

Each year, Swope Health serves over 45,000 patients, encompassing more than 200,000 visits to four counties on both sides of the state line. Our team members are proud of the work we do and the promise we've made – delivering coordinated care that values the needs of the whole person and championing better health in our community.

Swope Health is a special place that cares for the people who need it most, wherever they are in the community. As part of our promise to battle health inequities and provide high-quality, comprehensive care, we make care visible. That means we proudly deliver our promise through every action, every day.

Swope Health Services supports its team members with:

• Medical benefits (including a Health Savings Account option), dental and vision
• 401(k) retirement plan with company match
• Company-paid benefits such as life…