Serve as the primary contact for payor audits and direct Centria's external audit preparation, tracking, response and remediation processes.
Work collaboratively with operations, clinical, and quality assurance team members to address external Corrective Action Plans (CAPs) and to monitor necessary action items for completion.
Perform compliance audits of operational adherence to payor contract or CAP requirements.
Develop and maintain internal audit standards and protocols.
Develop and implement internal audit training on standards and protocols for internal audit staff.
Oversee the design, planning, and execution of internal audits completed by the Compliance Department.
Meet with stakeholders to report findings and advise on the Plan of Correction.
Monitor the progress and completion of all Plans of Correction that result from audit findings.
Monitor and control Internal Audit expenses throughout the year for the department's budget.
Other duties as assigned by the Chief Compliance Officer.
Compliance with Centria's Code of Conduct, policies and procedures, and Federal and State laws.
Responsibility to report violations of Company policies or the Code of Conduct.
This role is responsible for:
Leading and maintaining staff by interviewing, selecting, orienting, and training new team members;
Ensuring the daily functions of the department are completed by communicating job expectations, planning, monitoring, and appraising job results;
Managing, coaching, and developing a high performing team that meets agreed objectives and which delivers best practice results, added value, and continuous improvements;
Consistently promoting high standards through personal example and roll out through the team so that each member of the team understands the standards and behaviors expected of them.
Required Qualifications, Skills, and Knowledge:
Bachelor's degree required
Master's degree preferred
National Certification in Auditing or Healthcare Compliance, preferred
Minimum of 6 years' experience in the healthcare field with expertise in compliance auditing
Management or leadership experience
Excellent customer service and relationship skills
Basic computer skills
Working knowledge of laptop/desktop PC
Proficiency in Microsoft Suite
Proficiency in G Suite
Ability to follow written instructions
Ability to use computers and computer/software programs
Ability to communicate expressively and receptively
Excellent communication skills, both written and verbal;
Data-driven with an aptitude for interpreting results and firm adherence to process;
Comprehensive understanding of payor requirements and proficiency in navigating CareConnect;
Track record of success in payor audit responses;
Knowledge of ABA requirements for nationwide payors;
Strong understanding of Centria operational processes with the ability to work collaboratively with other departments in collecting documentation;
Knowledge of computer systems related to compliance, operational, and HR functions;
Knowledge of audit and compliance process;
Ability to organize, prioritize and handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks;
Proven adaptability with a willingness to
Benefits
Health insuranceVision insurancePaid time off
Additional Information
Position Overview:
The Director of Compliance Audit is an integral team member at Centria both inside and outside of the Compliance Department. This role requires an understanding of Centria's multifaceted operations and various shared service departments at the Resource Center. Building strong relationships and trusted collaboration with Executive Leadership and Centria Department Heads is a critical component of success in this role.
Under the direction of the Chief Compliance Officer, the Director of Compliance Audit has primary responsibility for the following elements of Centria's Compliance Program:
Monitoring all incoming payor audit requests, completing systematic audit tracking processes, conducting pre-audit assessments of potential deficiencies, coordinating audit responses, and providing oversight of the remediation of deficiencies identified by external auditors.
Overseeing the design, planning, and execution of all internal compliance audit initiatives across the company. These initiatives will include but are not limited to, validation audits on claims, accurate coding of health care services rendered, provision of services specific to federal/state law and contractual requirements, and compliance with Centria policies and procedures and internal controls.
Developing an Internal Audit Plan consistent with the annual Compliance Work Plan.
Centriahealthcare · Farmington Hills, MI