JOB PURPOSE:
The Compliance Auditor (CA) reports directly to the Vice President of Compliance (VPC) to conduct compliance audits for Health Care Centers (HCC), Hospice, Home Health and/or SOURCE/CCSP service lines. The CA performs routine and focused internal compliance investigations, audits and assessments throughout the organization and develops detailed reports of findings.
KEY RESPONSIBILITIES:
1. Demonstrates good analytical and organizational skills and the ability to collect, analyze and utilize data.
2. Possesses good people skills for effective liaison with department, company and agencies while maintaining objectivity, accuracy, and confidentiality.
3. Demonstrates knowledge of state and federal laws and regulations that apply to Home Health, Hospice and HCC operations and billing requirements. In addition to state policies related to community services.
4. Demonstrates knowledge of organizational processes, policies, procedures, and systems related to compliance audits and investigations.
5. Demonstrates knowledge and ability to manage the Medicare and Medicaid denials and appeals process.
6. Demonstrates ability to perform and document audits, including interview, observations, and record reviews timely.
7. Demonstrates ability to work well both independently and with others.
8. Demonstrates ability to assist with preparation of documents in response to external audits.
9. Maintains appropriate degree of confidentiality of company information.
10. Demonstrates the ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, governmental regulations, and legal documents.
11. Participates and contributes to team projects.
12. Performs other duties as assigned by the supervisor.
KNOWLEDGE, SKILLS, ABILITIES:

• This position requires an individual who is self-motivated, purposeful, and flexible to frequently shifting work priorities.
• Experience working in a licensed and/or federally certified long-term care or health care program or regulatory agency.
• Excellent communication and organizational skills.
• Ability to work unsupervised and to prioritize and manage multiple assignments with integrity.
• Experience working with computers and varied computer programs (Microsoft Word, Excel, TEAMS, Power Point)
• Excellent written and oral communication and organizational skills.
• Ability to perform internal compliance investigations and audits including compiling detailed reports with recommendations.
• Ability to develop or extract measurable standards from qualitative criteria.
• Ability to manage a demanding and diverse workload.
• Ability to participate in policy development.
• Ability to participate in training efforts with other partners.

LICENSURE, CERTIFICATION AND EDUCATION REQUIREMENTS:
Must be a Registered Nurse in good standing in at least one of the states in which PruittHealth operates. Active professional license is required and are to be renewed as appropriate following state regulations.
Knowledge of state and federal regulations for SNF, Home Health and/or Hospice preferred. Free from illegal use of drugs and alcohol in the workplace.
Persons who have been found guilty by a court of law of abusing, neglecting or mistreating individuals in a healthcare related setting or, who have been excluded from the Medicare and/or Medicaid program, are ineligible for employment in this position.
For new hires to meet the requirements of PruittHealth’s COVID-19 vaccination policy, a new hire must (a) have received their first shot prior to employment and complete their subsequent vaccine shots at the time interval required to become “fully vaccinated” or (b) obtain an approved exemption from the Organization as a medical or religious accommodation. A new hire must submit their intent to request an exemption after the new hire has signed the offer letter and prior to employment.
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As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.