Are you looking to use your analytical and attention to detail skills to add to our company’s internal control structure as a Senior Compliance Audit Analyst?”
Pathways is one of the largest national providers of accessible, outcome-based behavioral and mental health services. We are looking for a dedicated, detail-oriented, growth-minded Senior Compliance Auditor to join our team, helping to ensure our company’s continued compliance with internal and external regulations.
For your passion and dedication as a Senior Compliance Audit Analyst, we offer career advancement opportunities, medical/dental/vision, PTO, paid holidays, and much, much more (read below)! We realize your growth is paramount to our continued reputation of quality and service excellence, so we are ready to invest in YOU from day one!
About Your Role:
The individual in this role will be responsible for proactively identifying, monitoring, and auditing key areas of potential non-compliance, risk, fraud, waste, and abuse. Performing deep dive analysis and investigation of source documents and claims and other documentation related to the identified risk, the analyst will help identify root causes and solutions to risk-related issues thereby reducing or eliminating that risk. Based on the annual Compliance Audit Workplan and Timeline that targets departments of Revenue Cycle billing, HR, and Payroll, creates and implements quarterly audit work plans.
Responsibilities and Duties:
- Creates quarterly audit work plans based on overarching annual Compliance Audit Workplan
- Based on audit scope, creates audit checklists, identifies state-specific rules and regulations, source documents (i.e., SOP’s and P&’s), and sample sizes
- Performs holistic analysis in key areas of risk. Collaborates with corporate managers and supervisors to help identify, research, investigate, and resolve compliance issues related to the area of risk
- Identifies and publishes key areas of risk, non-compliance, opportunities to streamline processes, and root cause
- Designs and implements processes for monitoring and recommends educational opportunities
- Creates specific audit score carding and makes recommendations or creates corrective action plans as needed, to reduce or eliminate recurring issues
- Follows up on corrective action plans and establishes the re-auditing timeline as needed
- Facilitates and monitors compliance with an annual review for updates to policies, procedures, and other types of source documentation
- Performs analysis on newly created policies and procedures when needed and/or as requested
- Maintains proficiencies in the various EHRs, Avatar, Credible, and any reporting systems needed to perform responsibilities
- Helps drive or create necessary reporting that can be used to trend and identify risk areas
- Performs random claim audits nationwide that are not part of a specific state-wide audit utilizing denial reports, AR reports, and other reports that target or identify key areas of RCM related risk
- Provides oversight of the Medical Record Request Process and contributes to Critical Incident Liability Reporting to Insurance processes when necessary
- Demonstrates personal traits of a high level of motivation, team orientation, professionalism, and trustworthiness, placing a high value on treating others with dignity and respect
- Utilizes strong written and oral communication skills
- Handles and maintains confidentiality with sensitive communications with leadership, physicians, management, legal counsel, and regulatory agencies.
Requirements:
- Current driver's license and reliable transportation
- Bachelor’s Degree in business, or related field, or related experience and skill sets equivalent to a Bachelor’s Degree
- 3-5 years of previous healthcare-related experience in billing operations and/or compliance-related risk management activities
- Certification a plus
- Candidate must reside on East Coast
- Candidate must possess the flexibility to commute and work from a Corporate location upon request
Perks of Working Full-Time at Pathways:
Competitive Salary
- Paid Vacation Days (1st year 12 days; increases with tenure)
- Paid Sick Days (Accrual per pay period)
- 11 Paid Holidays (including Day after Thanksgiving, Christmas Eve, and your Birthday!!!)
- Medical, Dental, and Vision including a Health Savings Account or FSA
- Health, Dependent, and Transportation Flexible Spending Accounts
- Basic and Optional Life Insurance for Employee, Spouse and/or Dependents
- 401K
- Opportunities for advancement in our national company! As we grow, you grow with us!
- Employee Assistance Program
- Perks @ Pathways (student loan refinancing, pet insurance, Verizon wireless discount, movie, hotel, concert, and sporting event discounts)
If you're #readytowork Pathways is #readytohire!
Not the job you’re looking for?
Pathways has a variety of positions in various locations; please go to https://corporate.careerplug.com/jobs?locale=en-US
To Learn More About Us:
Pathways @ http://www.pathways.com/mission-vision-and-values/
Pathways @ https://www.pathways.com/
Pathways is an equal opportunity employer with a commitment to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity, disability, veteran status or any other protected characteristic.