Healthcare Compliance Auditor - Risk & Quality

Provider Network Solutions, LLC; Miami (FL); Remote; USD 70,000 - 110,000; Full time

Job summary

Provider Network Solutions, LLC is seeking a Compliance Auditor to review company and delegated entities’ practices for adherence to federal, state, and client regulations. The role involves auditing, interviewing executives, and recommending process improvements to achieve compliance.

The ideal candidate has 3–5 years in operational audits or regulatory compliance, healthcare knowledge, and strong communication. Preferably bilingual with a compliance certification and a BA/BS degree.

Qualifications

• 3–5 years’ experience in operational audits or regulatory compliance.
• Knowledge in Healthcare industry is preferred.
• Medicare, Medicaid, and Commercial Regulations knowledge.
• Compliance Certification is strongly desired.

Responsibilities

• Promote a strong code of ethics and integrity.
• Stay abreast of changes in healthcare laws, regulations and standards and advise on requirements.
• Assist in risk/issue identification and remediation within audits.
• Resolve compliance issues identified through audits and monitoring with department leaders.
• Monitor and maintain the quality of audited processes across departments.
• Analyze, organize and document audit findings and implement corrective actions.
• Conduct internal audits and present results to the Compliance Officer.
• Oversee external audits and manage data collection, analysis and submissions.
• Maintain audit records and CAPs logs with evidence of completion.
• Adhere to policies and serve as a liaison for the Compliance Program.
• Provide training and guidance on compliance matters.
• Perform other duties as required.

Skills

Microsoft Office

Presentation skills

Communication skills

Regulatory knowledge

Analytical skills

Time management

Attention to detail

AI knowledge

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

Provider Network Solutions, LLC is seeking a Compliance Auditor to review company and delegated entities’ practices for adherence to federal, state, and client regulations. The role involves auditing, interviewing executives, and recommending process improvements to achieve compliance.

The ideal candidate has 3–5 years in operational audits or regulatory compliance, healthcare knowledge, and strong communication. Preferably bilingual with a compliance certification and a BA/BS degree.