* Not remote position - In office - Authorization to work in the US is required *

Position Summary

The Compliance Auditor is responsible for the review of the company’s business practices, enforcing compliance with pertinent regulations, such as all federal and state relevant regulations and standards, applicable contractual requirements established by the organization’s clients and internal policies and procedures. Such audits and/or monitoring may occur annually or at other intervals and may include reviewing documentation and other records, as well as interviewing executives and employees. In instances where an operational department is not in compliance with a regulation or set of regulations, the Compliance Auditor is responsible for recommending improvements to our internal business processes and ensuring that the operational department comes into compliance. In addition, the Compliance Auditor is charged with evaluating the plan to implement any needed change, ensuring that steps within the plan are effective and addressing the root cause of the noncompliance issue.

Duties and Responsibilities

• · Promote a strong code of ethics and integrity within the company’s operations.
• · Stay abreast of regulatory changes, including, but not limited to, Medicare, Medicaid and Commercial regulations and advise the company of requirements and changes, if any, required to be implemented by company.
• · Resolve compliance issues identified through internal and/or external audits or monitoring, while working closely with all operational department leaders to ensure prompt response to the compliance issues and that effective procedures are in place.
• · Assist in risk/issue identification and remediation within the external and internal audits.
• · Responsible for monitoring and maintaining the quality of the audited processes performed in each of the departments in accordance with the applicable lines of business and specialty network and collaborating with the Compliance and Audit Manager and Compliance Officer to improve processes.
• · Responsible for analyzing, organizing and documenting the findings arising from the audit and/or monitoring exercises, preparing reports containing findings, and requesting and implementing corrective action plans.
• · Conducting internal audits, developing quality indicators to measure standards, developing internal audit tools as necessary and presenting the results of evaluations/audit reports to the Compliance and Audit Manager.
• · Handle and oversee all external audits, ensuring that all steps are performed in a timely manner, such as but not limited to: Universes, questionnaires, samples and any request for information review, analysis, audit notices dissemination to impacted operational departments, recommendations for correction, internal discussions, preparation of data for final submission and receipt of formal closing notice.
• · Maintain organized and up to date all audits’ records within the organization’s systems.
• · Promptly address any Corrective Action Plans (CAPs) and/or non-compliance issues identified through an external audit with applicable operational department leader and ensure accurate, effective, and complete evidence of completion is provided to the Health Plan auditor in a timely manner.
• · Maintain the Audits and CAPs log and its evidence updated and well organized.
• · Adhere to organizational policies and procedures to ensure compliance with the Compliance Program and contractual requirements, while serving as a departmental liaison to assist with the functions of the Compliance Program .
• · Comply with performance standards as set forth by the Compliance department head.
• · Perform other duties as required and assigned.

Knowledge

• Bilingual, written and spoken (preferred)
• Bachelor’s degree preferred
• Requires 3-5 years’ experience in operational audits, regulatory compliance or government regulations or any combination of education and experience, which would provide an equivalent background.
• Knowledge in Healthcare industry preferred
• Medicare, Medicaid, and Commercial Regulations knowledge
• Relevant experience in law, ethics, organizational business, finance, or statistical analysis
• Experience in Audits and Monitoring processes.
• Compliance Certification is strongly desired

Skills

• Proficient in Microsoft Office (word, excel and PowerPoint)
• Excellent presentation skills
• Must possess strong verbal and written communication skills (ability to communicate effectively with leadership and build relationships)
• Excellent research and analytical skills
• Thorough understanding of business requirements and excellent problem-solving skills
• Must be detail oriented and have excellent organizational and time management skills

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Miami, FL 33178: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• What is your salary range?

Language:

• English (Required)

Work Location: One location

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