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Years of Experience
Date Last Verified
Internal Audit Associate - Non-Clinical The candidate will assist the Chief Compliance Officer in developing the Internal Audit Compliance Work Plan. Will conduct internal audits as assigned in accordance with organization policies and procedures and CMS audit tools and industry and accrediting organization standards to evaluate compliance with applicable laws, regulations, and policies and rapidly detect potential issues, problems or violations. Communicate audit information such as results and conclusions in accordance with departmental policies and procedures. Render non-biased audit reports; communicate and interact professionally. Work collaboratively with senior management to develop corrective action plans and corrective action validation audits. Assist Audit Coordinators, as needed, with financial and payer audits. Assist with building performance improvement and operational efficiency within the company through internal audit and risk assessment functions. Maintain strict confidentiality of all audit projects, results, conclusions and reports. Maintain patient confidentiality and function within the guidelines of HIPAA. Participate in educational programs as required. Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation requirements is needed. Knowledge of CMS DMEPOS Supplier Standards, Quality Standards, accrediting organization standards; local, state and federal regulations are essential. Strong Math and reasoning skills. Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages along with the ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. For example; ability to apply problem solving skills to deal with issues involving concrete variables in standardized situations are needed. Ability to communicate effectively in both oral and written form; specifically able to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of employees of the organization are essential. Strong analytical problem solving; Anticipates potential issues and recommends potential solutions and/or alternatives, proactive in finding compliance solutions are needed. Demonstrates initiative and also uses sound judgment to determine when to escalate sensitive matters or issues of a critical natural needing more immediate or specialized attention is essential. Ability to maintain confidentiality related to extremely sensitive matters is needed. Demonstrates a high degree of persistence and follow-up and capable of independent research to determine compliance requirements as well as best practices in the industry is essential. Demonstrated experience and skills with Access, Word, and Excel, PowerPoint, and WebEx tools required is needed.
Qualification and Experience
The candidate should have GED or high school education is required. Certified Professional Coder (CPC) Credential required for Non-Clinical Associate. Bachelor’s Degree from an accredited School/Institution required for non-clinical position is essential. Paralegal experience is a plus. Should have 5+ years Medical experience required, experience in a DMEPOS billing and reimbursement environment. Experience with healthcare-related compliance requirements is a plus.
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