Recovery Innovations Inc.
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at Recovery Innovations Inc.
Job Status: Full Time
Job Reference #: 526a891b-ebed-4d67-bf2b-48f000f2b20b
- The Compliance Auditor, under the general supervision of the Director of Quality and Compliance, provides professional support in conducting compliance program activities that are necessary to operationalizing the RI International Compliance Plan. This includes conducting audits, investigations, analyzing data, and assessing the effectiveness of improvement plans designed to reduce compliance risks throughout the organization.
Essential Job Functions
*Conducts audit & monitoring activities as identified in the Agency’s Audit & Monitoring plan, including development of audit tools, research of relevant requirements, policies and practices, and conducting audit activities.
*Is authorized to have access to any information, deemed necessary by the Director of Quality and Compliance, relevant to the integrity and accuracy of the audit activity.
*Coordinates with leadership from various areas to ensure the scope of review aligns with the purpose articulated in the Audit & Monitoring plan and to minimize impact of audit on day-to-day operations and provision of services.
*Documents and reports audit findings consistent with the Agency’s policy and procedure, including recommendations for improved internal controls or other corrective actions.
*Tracks and reports the status of corrective actions and audits assigned to non-compliance department staff.
*Participates in data mining activities, including development of reports and providing data analysis reports to the Director of Quality and Compliance and Compliance Committee.
*Conducts preliminary reviews and investigations of alleged corporate compliance violations, including alleged fraud, waste or program abuse, conflicts of interest, or other violations of the Code of Conduct, when directed by the Director of Quality and Compliance.
*Assists in documenting the receipt of all reports to the compliance department, including a summary or the allegation, findings and resolution of the allegations.
*Reviews proposed corrective actions to assess for effectiveness, and coordinates with other departments, such as Human Resources, when appropriate.
*Assists the Director of Quality and Compliance in preparing reports for the Compliance Committee and Board of Directors, including investigation findings, recommendations, and trending of investigation data.
*Monitors and reports on the status and effectiveness of the corrective actions.
Training and Awareness
*Assists with preparation, coordination and presentation of new employee, annual and ad hoc compliance training activities.
*Assists with creating and implementing employee compliance awareness activities.
*Assists the Director of Quality and Compliance in assessing the effectiveness of compliance training efforts through analysis of data, employee feedback and other information to assess the effectiveness of compliance trainings.
- Cooperatively works as a team member with the ability to work well with supervisors and co-workers.
•Participates in agency committees, including preparation of presentations to the Board of Directors as designated.
•Models, supports and actively participates in the implementation of the Agency’s Mission Statement, Values and Philosophy and the ethical standards articulated in the Compliance Plan and Code of Conduct.
•May be required to travel.
•Performs other related duties as required or assigned.
•Associates degree and two (2) years of medical coding experience required. The ideal candidate will have at least one (1) year of experience working in mental health coding, and one (1) year experience conducting audit and investigations related to healthcare compliance and billing.
•Certified professional Coder preferred
•Knowledge and experience with personal computer software including word processing, spreadsheets, statistical analysis, and graphics.
•Knowledge and understanding of Medicaid requirements, Medicaid payment methodologies and compliance program requirements.
•Knowledge of federal and state laws related to fraud, waste and program abuse, including the False Claims Act, Anti-Kickback and exclusions, and conflicts of interest preferred.
•May be required to successfully pass pre-employment physical examination.
•Must successfully pass pre-employment background check.
•Must successfully pass pre-employment drug screen.
•Must be able to comply with the Organizations Driver’s Safety policy.
• Works in an office environment and/or behavioral health clinic and may sometimes travel to meet the business needs.
• Works a standard work week but may be required to work some evenings and weekends to monitor program activities.
Works in a standard office environment with some exposure to hazardous situations. Physical demands may include work close to the eyes and substantial motions of the wrist, hands, and/or fingers. Occasional sitting, standing, walking, handling, finger dexterity; eye-hand-foot coordination, use of corrected vision; color vision; use of auditory senses. May be required to lift up to twenty (20) pounds.
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