Compliance Audit Specialist

Position Summary:

The Compliance Audit Specialist reports to the VP of Compliance and will assist with and support the compliance program activities of Clinical Pathology Laboratories (CPL). The Compliance Audit Specialist will support the compliance department through auditing/monitoring, planning, education, assessment, and other compliance program functions including any existing compliance activities, with a particular focus on clinical/billing compliance and data analytics. They will also assist with such activities as policy and procedure development and maintenance, hotline monitoring and compliance complaint investigations, and training throughout the company.

Principal Responsibilities:

• Auditing and Monitoring
  • Perform annual compliance department risk assessment to develop annual department work plan
  • Design data tracking systems to detect, monitor, audit and track data to aid in identifying risk areas and correct non compliances
  • Prepare compliance audit data by compiling and analyzing internal and external data
  • Manage audits of federal and state exclusion sanctions lists for employees, vendors and clients
  • Monitor annual and new hire compliance and HIPAA training
  • Review and audit revenue billing cycle functions including but not limited to, ABNs, standing orders, charge master, and denials
  • audit findings, communicate to and recommend corrective strategies to agency
  • Establish and refine, as needed, systems to effectively audit and monitor CPL compliance with rules and regulations applying to laboratory operations.
    
• Compliance Inspections of CPL laboratories and phlebotomy locations
  • Using established inspection tools to identify non-compliances and prepare written report
  • Provide guidance for corrective action, track completion and monitor success. Participate in employee education
    
• Other compliance department responsibilities
  • Communicate, promote and exemplify the Compliance Plan and Standard of Conduct to employees in a useful and understandable format
  • Provide guidance about regulations affecting laboratories to staff when requested
  • Continuous reeducation regarding current and updated regulations using sources which include Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Board of Medical Examiners, the State Department of Insurance and local carriers in each state.
  • Participate in compliance updates and education at manager meetings, phlebotomy meetings, new sales training, QI Ops calls, etc.
  • Remain current with all applicable laws, rules and regulations
  • Medicare and Medicaid Enrollment

Education:

• Bachelor’s Degree; preferred concentrations: Chemistry, Biology or Medical Technician, Healthcare Compliance, Health Sciences, Healthcare Data Science, and Healthcare Administration.
• Preferred: Certification in Healthcare Compliance and/or Certification in Medical Coding and Billing

Experience:

• Minimum of three years in laboratory training and/or experience in a medical laboratory

Skills:

• Good knowledge of laboratory medicine at both the technical and administrative levels
• Highly developed analytical skills for both qualitative and quantitative data
• Ability to plan and lead projects following tight deadlines
• Demonstrates a high-level of attention to detail and accuracy
• Excellent communication skills - strong verbal and written skills
• Ability to exercise initiative, discretion, and judgement
• Ability to provide sound advice and guidance to managers and employees in supporting governance and compliance matters