Compliance Audit Specialist

Community Hospice and Palliative Care; Jacksonville (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

23 days PTO

Job summary

Community Hospice & Palliative Care in Jacksonville seeks a Compliance Audit Specialist to lead medical record reviews and audits, ensuring adherence to internal policies and external regulations. The role supports the Quality and Compliance program and training development.

You will work full-time at our main location, Monday–Friday, with a benefits package. Required RN licensure in Florida and 3–5 years of healthcare auditing experience are essential, along with strong analytical skills and

Qualifications

• RN licensure in the state of Florida.
• Bachelor’s degree preferred, in nursing or business-related field.
• 3–5 years of healthcare auditing or medical chart review experience.

Responsibilities

• Performs medical records reviews to ensure regulatory compliance.
• Assist with audit design and independently completes reviews.
• Consults with staff to clarify clinical data and educate on payor requirements.
• Processes documentation requests from Medicare, Medicaid and third-party payors.
• Identifies denials and supports documentation improvements.
• Coordinates the appeals process and maintains tracking logs.
• Provides updates to the Director of Quality and Risk Manager.

Skills

RN license

Regulatory compliance

Medical chart review

Auditing

Healthcare regulations

Education

Florida RN licensure

Bachelor’s degree preferred

3–5 years healthcare auditing experience

Job description

4266 Sunbeam Rd, Jacksonville, FL 32257, USA

Job Description

Awarded 'Great Place to Work' ™ Certification Once Again!

Behind every award is a story, and ours is written every day by more than 900 dedicated employees and hundreds of compassionate volunteers who walk alongside patients and families when they need us most.

At Community Hospice & Palliative Care, we’re honored to bring clinical excellence and compassion to every bedside, every home, every conversation. Every day, we serve approximately 1,500 patients living with advanced illness, wherever they call home, be it a private residence, a long-term care or assisted living facility, a hospital, or in one of our nine inpatient care centers.

We’re here to improve quality of life, to ease pain and lift burdens, and to be the Compassionate Guide that families need when time matters most. And most importantly, as the only non-profit hospice provider in the region, we never turn anyone away due to an inability to pay.

Compliance Audit Specialist

The Compliance Audit Specialist conducts medical record reviews and other audits to monitor for compliance with internal policies and external regulations. S/he assists in implementation of the Quality and Compliance Management Program including the development of policies and procedures and implementation of compliance training.

• Education Required: Registered Nurse (RN) license, current
• Work Location: Community Hospice and Palliative Care main location; 4265 Sunbeam Road, Jacksonville, FL. No work from home at this time.
• Days/Hours: Monday - Friday 8:00am - 5:00pm
• Compensation: Commensurate with experience; full benefits package including 23 days annual PTO

Job Responsibilities

Performs medical records reviews for services provided by the agency to ensure compliance with regulatory requirements, including, but not limited to, documentation requirements and appropriateness of care.

• Assist with audit design.
• Independently completes medical record reviews and audits within
• Consults with agency staff for clarification of clinical data. Facilitates and improves organization staff’s understanding of payor and regulatory requirements by providing feedback related to documentation.

Processes additional documentation request received from Medicare, Medicaid and third-party payors to ensure compliance and the maximization of appropriate organization reimbursement.

• Conducts medical record reviews related to additional documentation requests.
• Identifies potential denials and works with organization staff to strengthen documentation where appropriate.
• Coordinates the additional documentation request process including maintenance of tracking logs and preparation of cover letters as required.
• Provides updates/reports to the Director of Quality and Risk Manager regarding the status of additional documentation requests.

Participates in review of claims denied by Medicare, Medicaid and third-party payors to ensure both compliance and the maximization of appropriate organization reimbursement.

• Assists with the medical record reviews related to denials and documents findings.
• Prepares appeals for denial when appropriate based on the review of medical records or coverage criteria, including preparation of appeal templates, forms, and cover letters, as required.
• Coordinates the appeals process including maintenance of tracking mechanisms throughout the review process to a final determination.
• Prepares reports for the Risk Manager and Director of Quality regarding the status of open denials and appeals.
• Participates in the development and implementation of identified improvements to systems/procedures related to reasons for claim denials.

Investigates, responds to, and communicates information regarding documentation, compliance, and reimbursement questions.

• Compiles and analyzes data.
• Supports, provides analysis for, and advises management regarding documentation issues.
• Analyzes documentation issues/questions from a compliance perspective.
• Develops and implements a system for documenting and communicating responses to all compliance questions.

Identifies and communicates educational needs based on clinical record audits and other regulatory audits to the Director of Quality and/or appropriate compliance team member.

Assists in developing and providing compliance education to organization staff, including clinical documentation and regulatory changes.

• Provides accurate and up-to-date information on regulatory requirements.
• Provides expertise for compliance issues.
• Assists in the development of compliance education materials.
• Prepare reports and graphics for presentations.
• Maintains attendance lists for all presentations and logs of issues raised and identified for future research and response.

Maintains current knowledge of industry regulations, issues and best practices and ensures appropriate dissemination and communication of changes to the appropriate members of the Compliance Department.

Participates as an active member of agency committees as assigned, including attending meetings and reporting on projects and findings as requested. Participates in Team Rounding to patient care teams to solicit feedback and/or provide regulatory updates and education.

Assists management with special projects and performs other duties as may be required to support the organization’s compliance program

Education & Experience Needed

• Registered Nurse (RN) licensure, state of Florida.
• Bachelor’s degree preferred, in nursing and/or business-related field.
• Three to five (3 to 5) years on-the-job experience in healthcare auditing, medical chart review, healthcare consulting, insurance company/intermediary, or may consider clinical experience.

Desired Knowledge, Skills, and Abilities

• Demonstrated proficiency with applicable laws and regulations including Medicare, Medicaid, and other third-party payors.
• Proficiency in reading medical records.
• Knowledge of general research methods, including, but not limited to, research of health care regulatory requirements.
• Ability to evaluate medical necessity using governmental regulatory and private payor guidelines and nursing judgment.
• Ability to solve practical problems and exercise independent judgment in planning work details and making technical decisions related to audits.
• Must be detail oriented with strong organizational and multi-tasking skills to meet scheduled deadlines.
• Previous hospice work experience preferred.

Community Hospice & Palliative Care, including all of its subsidiaries and affiliated companies, is committed to complying with all applicable provisions of the Americans with Disabilities Act (ADA), as amended. We provide reasonable accommodations to qualified individuals with disabilities to ensure equal access to employment opportunities and the ability to perform the essential functions of a position. If you require an accommodation to complete the application process, interview, or perform the essential functions of a role, please contact Human Resources at [e-mail].

We participate in E-Verify to confirm the employment eligibility of all newly hired employees.

Where applicable, and as required by law, employment with Community Hospice & Palliative Care may be contingent upon successful completion of a background screening initiated by the organization through the Florida Agency for Health Care Administration (AHCA) Background Screening Clearinghouse. More information about the Clearinghouse, including positions that require screening, can be found here: https://info.flclearinghouse.com .

Equal Opportunity Employer

4266 Sunbeam Rd, Jacksonville, FL 32257, USA