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Audit Analyst, Compliance, Privacy & Risk Management

Job Summary:

The Audit Analyst for Compliance, Privacy & Risk Management is responsible for the oversight and management of auditing and monitoring high-risk, problem prone processes, completing compliance risk assessments to ensure compliance with federal/state laws and regulations, and ArchWell Health policies.

Duties/Responsibilities:

• Adheres to assigned audit schedule and reviews as outlined in the Compliance Workplan
• Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests.
• Conducts audits and focused reviews to ensure compliance with company, government, and payor guidelines.
• Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc.
• Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting.
• Maintain a working knowledge of HIPAA, HHS, and CMS regulations.
• Participate in the planning and scheduling of compliance projects.
• Research compliance related questions upon request from departments and/or practices.
• Identify and report potential audit and compliance risks.

Required Skills/Abilities:

• Knowledge of Medicare and Medicaid documentation and coding rules and guidelines.
• Must have an understanding and knowledge of national and state laws and regulations
• Must have excellent verbal and written communication skills.
• Strong interpersonal skills
• Strong organizational and planning skills.
• Demonstrates a high degree of personal integrity and practice ethical standards.
• Demonstrates proactiveness and ability to work independently and self-directed in managing multiple concurrent projects.
• Excellent analytical and problem-solving skills.
• Advanced skills in all MS Office applications (Word, Excel, Outlook, and PowerPoint).
• Ability to interpret and apply documentation and coding rules and regulations.
• Ability to demonstrate competence in performing audits, produce reports, formulate remediation or mitigation plans, and conduct follow-up audits.

Minimum Qualifications:

• Equivalent of 5+ years’ experience in compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or health care compliance
• Experience in compliance and privacy auditing techniques and methods
• Certified in Healthcare Compliance (CHC) or Certified in Healthcare Privacy Compliance (CHPC) preferred
• Bachelor's degree in related field preferred
• Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) preferred

At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life. 

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members. 

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.