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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileInternal Auditor/Compliance Officer Duties: Oversees the Corporate Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. The position ensures the Board of Commissioners, management and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the Hospital's Code of Conduct. Acts as a channel of communication to receive and direct compliance issues to appropriate resources for investigation and resolution, and as a final internal resource with which concerned parties may communicate after other formal channels and resources have been exhausted. Acts as staff to the CEO and Board of Commissioners by monitoring and reporting results of the compliance/ethics efforts of the company and in providing guidance for the Board and senior management team on matters relating to compliance. Authorized to implement all necessary actions to ensure achievement of the objectives of an effective compliance program. Perform and control the full audit cycle including risk management and control management over operations' effectiveness, financial reliability and compliance with all applicable directives and regulations. Determine internal audit scope and develop annual plans. Obtain, analyze and evaluate accounting documentation, previous reports, data, flowcharts etc. Prepare and present reports that reflect audit's results and document process. Act as an objective source of independent advice to ensure validity, legality and goal achievement. Identify loopholes and recommend risk aversion measures and cost savings. Maintain open communication with management and Board of Commissioners. Document process and prepare audit findings memorandum. Conduct follow up audits to monitor management's interventions. Engage in continuous knowledge development regarding healthcare industry rules, regulations. Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manages day-to-day operation of the Program. Develops and periodically reviews and updates the Code of Conduct to ensure continuing currency and relevance in providing guidance to management and employees. Collaborates with other departments (e.g., Risk Management, Legal Services, Human Resources, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the General Counsel as needed to resolve difficult legal compliance issues. Responds to alleged violations of rules, regulations, policies, procedures, and Code of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations. Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved. Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. Provides reports on a regular basis, and as directed or requested, to keep the Board of Commissioners and senior management informed of the operation and progress of compliance efforts. Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required. Establishes and provides direction and management of the Compliance Hotline. Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Code of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. Works with the Human Resources Department, Training and Development Department, and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers. Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness. Performs other duties as assigned or directed to ensure smooth operation of the organization. Preferred: Proven experience serving as a Compliance Officer in a Hospital or other healthcare organization. Expertise in Medicare / Medicaid reimbursement and regulations, HIPAA and HITECH regulations, conducting investigations, healthcare operations, Stark law, anti-kickback laws, and fraud, waste and abuse. Professional attitude and skills to relate to executive management, professionals and business and community leaders.
Qualification and Experience
Qualifications: BS degree in Accounting or Finance, or related field. 3-4 years of financial auditing experience in a hospital or in public accounting performing audits for hospitals. JD Degree and/or Masters in Business (or Healthcare) Administration or Certified Public Accounting certification; 5 years' experience in a healthcare organization, to include demonstrated leadership; Certified Internal Auditor; CHC (Certified in Healthcare Compliance), CHPC (Certified in Healthcare Privacy Compliance), CHRC (Certified in Healthcare Research Compliance) or other related health care compliance certification are preferred. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must. Advanced computer skills on MS Office, accounting software and databases. Ability to manipulate large amounts of data and to compile detailed reports. Proven knowledge of auditing standards and procedures, laws, rules and regulations. High attention to detail and excellent analytical skills. Sound independent judgment.