Medical Compliance Auditor

  • Altamonte Springs, FL, USA
  • Contract

Company Description

Here at CiNQ Recruitment, we believe in finding the right fit, for you and our clients. Whether you seek long-term employment solutions for your business or your next career move, we understand the importance of individual and business needs. With over 30 years of successful staffing and recruiting experience, we excel at providing passive candidates with the right skills and cultural fit for specialized positions. Here is the opportunity to work with an exciting pharmaceutical company.

Job Description

Job Type: 1 year Contract; POSSIBLE extension or perm

Shift: Mon- Fri 8am-5pm; onsite

Pay: $18-$24/hr

Hiring Manager Notes:

  • Will be auditing our financial operations such as the billing and claims data.
  • Will be verifying that they are not subject to any compliance/legal issues (STARK, False Claims Act, Anti Kickback, etc).
  • Should know about Medical RCM, insurance terminology, and Specialty Pharmacy is ideal.
  • Will report directly to the Chief Compliance Officer.
  • Needs to be well spoken and professional. Be able to communicate with CCO and other senior executives of any issues or trends that you are finding.

Position Summary:

  • The Compliance Auditor supports the Chief Compliance Officer (CCO) to ensure the Pharmacy’s adherence to federal and state laws, regulations, industry standards, and guidelines affecting patient services, operations, and business transactions.
  • This position works collaboratively with departments throughout the organization as directed by the CCO to support, maintain, and improve compliance, operational, and quality standards.

Essential Functions:

  • Performs periodic internal compliance audits on at least a quarterly basis throughout the calendar year to examine adherence to legal, operational, financial, and policy requirements.
  • Conducts compliance monitoring activities on an ongoing basis as instructed by the CCO or Executive Leadership.
  • Conduct audits concentrating on medical billings, claims payments, and financial data.
  • Documents and reports all corporate compliance violations to CCO and/or Executive Leadership during the course of conducting audit inquiries, questions, and investigations, and on an ongoing basis thereafter, as required.
  • Assists or leads Department efforts to examine or identify operational or compliance indicators, trends, or problems, as assigned.
  • Conducts interviews with department staff as required.
  • Conducts Root Cause Analysis, as needed, during compliance audits, monitoring, investigations, or inquiries, as required.
  • Collaborates with all staff, IT, and other stakeholders as required, on all targeted compliance audits in order to meet applicable legal and industry requirements.
  • Drafts final audit report findings and observations with recommendations to the CCO.
  • Serves as a subject matter resource/liaison regarding compliance audits conducted by the Compliance Auditor.
  • Supports all functions related to Compliance Department internal/external reporting activities.
  • Supports the CCO in the administration of the company's compliance program and objectives.
  • Actively supports the company's Core Values and Mission through professional behavior and daily job performance.

Competency:

  • Knowledge of standard medical/pharmaceutical terminology
  • Proficiency with medical billings, claims, and financial data. •
  • Knowledge of deductibles, copays, and coinsurance.
  • Ability to learn quickly, solve problems, and make recommendations. • Working knowledge of Adobe and CPR+ (preferred)
  • Ability to run, read and analyze reports and statistical data.
  • Ability to work cooperatively and handle multiple projects.
  • Demonstrate excellent oral, presentation, and written communication skills

Education/Experience Requirements:

  • Proficient with and knowledge of medical claims, billing, and revenue cycle operations.
  • Understanding of specialty pharmacy products and services.
  • 1-2 years of medical/pharmaceutical experience required.
  • Minimum 1 year of Specialty Pharmacy experience preferable

Job Types: Full-time, Temporary

Pay: $18.00 - $24.00 per hour

Additional Information

All your information will be kept confidential according to EEO guidelines.