QUALITY & COMPLIANCE AUDITOR
The Compliance Auditor support the Compliance Program Effectiveness by evaluating Alivia Health Operations and business practices to ensure compliance with the regulatory requirements, laws, and regulations. The Compliance Auditor is accountable for conducting regular audits, supervise the general quality of Alivia Health medical system, compliance, and auditing projects and assess their adherence to industry standards, corporate policies, and federal and state laws. Other responsibilities include ascertaining the efficacy of the internal control structure and risk management procedures and making objective reports on their performance.
Responsibilities include, but are not limited to:
- Comply with the established Audit & Monitoring Workplan conducting the audits and monitoring initiatives in a timely manner.
- Prepare, manage, and monitor the corrective action plans in response to audit or monitoring findings and compliance violations.
- Support the Compliance Staff in preparation and participation of meetings with operational management. Able to explain, anticipate, measure, and forecast concepts based on data gathered and managed.
- Documents and reports the compliance violations to Quality and Compliance Director and/or Executive Leadership during the course of audit or investigations, and on an ongoing basis thereafter, as required.
- Conduct detailed audits of the company's business processes to identify and eliminate compliance risks.
- Inform the staff and administrators about potential regulatory changes and recommend strategies that establish compliance.
- Enforce compliance programs through timely detection of misconduct and the creation of pertinent corrective actions plans.
- Gather, analyze, and summarize management information to compile relevant compliance reports.
- Document audit tests and findings to complete audit-related documentation and memorandums
- 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 on all targeted compliance audits to meet applicable legal and industry requirements.
- Drafts final audit report findings and observations with recommendations to the Quality and Compliance Director.
- Serves as a subiect matter resource/liaison regarding compliance audits conducted.
Supports all functions related to Compliance Department internal/external reporting activities.
- Research healthcare industry compliance regulations and evaluate Alivia Health network internal operational and procedural compliance.
- Collects, prepares, reviews, and submits requested information, data, and documents to Executive Management Staff.
- Work with business units' heads and staff to identify monitoring areas; collect, analyze, and interpret data and report results of monitoring initiatives.
- Collaborate with the quality and privacy team, as needed to meet department goals, and perform other duties as assigned.
- Supports the Quality and Compliance Director in the administration of the Compliance Program and objectives.
Actively supports Alivia Health Core Values and Mission through professional behavior and daily job performance.
- Bachelor's Degree is required in Business Administration, Information Management, Accounting, Healthcare Administration, or related field.
- CHC or CHCP Certification
- Certified Risk and Compliance Management Professional (CRCMP)
- Certified Internal Control Auditor (CICA)
- Certified Sarbanes-Oxley Professional (CSOP)
- Minimum of three (3) years of experience in Compliance or Pharmacy Audit or related field experience in health or health care industry; three (3) years of experience in conducting monitoring/audits, and/or data analysis.
- Previous experience as a compliance analyst in a related field, preferred.
- Knowledge of pharmacy industry or managed care compliance requirements and standards, preferred.
- Ethical leadership skills and able to lead by the values of the organization.
- Ability to keep sensitive information confidential.
- Ability to maintain objectivity and lack bias in evaluations.
- Critical thinking ability (analytical) with excellent organizational skills.
- Detail oriented
- Knowledge in privacy-related regulation such as HIPAA.
- Fully bilingual in English and Spanish (Written and Verbal)
***Equal Opportunity Employer F/M/V/D/S/A***
Alivia Health00968, PR
Finance and Insurance
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