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COMPLIANCE AUDITOR Job in durham, North Carolina

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Employer:Duke University and Duke Health System
Preferred Certifications:RHIA,Research compliance certification CHRC,CCS,or RHIT),Coding certification (e.g. CPC,or applicable experience is required.
Required Experience:3 to 4 years
Preferred Experience:3 to 4 years
Location: durham 27705, NC, US
Date Posted:9/30/2020

Compliance Auditor

Job Code: 5119
Job Level: G1

Supervisory Responsibility: Yes

Conduct health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations pertaining to but not limited to: federal healthcare program requirements, clinical trials billing, privacy, conflict of interest, and anti-kickback and physician relationships.


Work Performed
- Interpretation of applicable federal and state law and regulations to plan audit parameters, determine department's compliance with such regulations and communicate to department necessary changes in compliance with regulatory requirements.
- Responsible for conducting non-routine audits, documenting & communicating findings and recommendations, explaining regulatory requirements, and overseeing the corrective actions for audits within DUHS
- Conduct risk assessments and preparation of work plans.
- Develop an understanding of the operations, system processes and procedures used in areas being audited.
- Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents and investigation of irregularities and errors.
- Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations; perform subsequent audits to ensure complete and appropriate corrective action.
- Develop recommended corrective actions to address issues detected.
- Actively participates in exit conferences, providing clarification and supporting information necessary.
- Provide education for providers and staff


Required Qualifications at this Level


Work requires a general business background generally equivalent to a Bachelor's degree in a business administration, accounting, management, healthcare administration, other related degree.


Four years of experience related to legal, regulatory compliance, patient advocacy, supervisory role in patient financial services or HIM services, or other relevant experience.

Degrees, Licensure, and/or Certification


Knowledge, Skills, and Abilities

Knowledge of billing compliance, knowledge of Medicare/Medicaid regulations, including billing, coding and documentation requirements. Coding certification (e.g. CPC, CCS, RHIA, RHIT) or applicable experience is preferred.

In depth knowledge of federal regulations

Strong oral and written communication skills.

Distinguishing Characteristics of this Level


Coding certifications (e.g. CPC, CCS, CIC, RHIA, RHIT) and coding experience is strongly preferred. 


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