Regulatory Auditor

Dartmouth Health; Lebanon (Lebanon County); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a detail-oriented Auditor to enhance operational efficiency and compliance. This fully remote role involves planning and executing audits, conducting risk assessments, and ensuring adherence to regulations. Ideal candidates will possess a Bachelor's degree in a relevant field and strong analytical skills. Join a dynamic team committed to excellence in healthcare operations, where your insights will drive significant improvements and shape compliance strategies. If you're passionate about making a difference in healthcare, this opportunity is perfect for you.

Qualifications

• 3+ years of experience in regulatory/clinical issues and coding.
• Strong understanding of healthcare operations and compliance.

Responsibilities

• Plan and execute auditing projects as requested by management.
• Conduct risk assessments and develop audit programs.
• Prepare reports and recommendations for operational leaders.

Skills

Analytical Skills

Project Management

Critical Thinking

Interpersonal Skills

Education

Bachelor's degree in Business

Healthcare Administration

Health Information Management

Tools

Microsoft Word

Microsoft Excel

Job description

Overview

Plans and performs procedures to audit and monitor the completeness, accuracy, and timeliness of documentation, coding, billing, reimbursement, and operational efficiency and effectiveness, ensuring compliance with rules and regulations. Conducts research, analysis, and interpretation of laws, regulations, and internal control theories to evaluate systems and processes supporting operational and compliance objectives. Performs complex professional and facility (DRG or APC) coding and billing audits across all clinical specialties.

Responsibilities

1. Plan and execute auditing and monitoring projects as requested by Senior Management and the Audit and Compliance Committee of the Board of Trustees.
2. Participate in and document risk assessments to develop and prioritize audit programs; coordinate and support the execution of operational, legal, and system compliance audits.
3. Conduct and document risk assessments of organizational objectives during audits; monitor risks continuously and communicate findings to senior auditors and management for appropriate action.
4. Design and perform audit procedures, including analytical reviews, internal control assessments, and substantive tests according to audit plans.
5. Assist in developing and implementing the annual Risk Assessment and audit plan.
6. Research, analyze, and interpret reimbursement laws, regulations, and other sources to support operational and compliance goals.
7. Analyze testing results to draw conclusions related to audit objectives.
8. Prepare documentation and reports for presentation to operational leaders, senior management, and the Audit and Compliance Committee, including recommendations for improvements and management action plans.
9. Participate in daily activities of the Compliance office, review complaints, conduct investigations, and assist in developing action plans.
10. Support the development, management, and continuous improvement of compliance plans and policies.
11. Conduct oversight reviews and audits to evaluate compliance with plans, policies, and procedures; recommend improvements.
12. Organize engagement work papers, develop checklists, programs, and templates to support engagement objectives and meet professional standards.
13. Identify opportunities for process improvements; track time and effort for performance evaluation.
14. Perform additional duties as assigned.

Qualifications

• Bachelor's degree in Business, Healthcare Administration, or Health Information Management, with at least 3 years of relevant experience, or equivalent education and experience in regulatory/clinical issues, chart abstraction, CPT and ICD-9 coding, and clinical documentation.
• Understanding of healthcare operations, audit, compliance, and relevant laws and guidelines.
• Knowledge of chart abstraction, CPT, ICD-9 coding, and clinical documentation is highly desirable.
• Strong analytical, critical thinking, and project management skills.
• Proficiency in computer applications including word processing and spreadsheets.
• Ability to work independently or in a team.
• Excellent interpersonal, written, verbal, and presentation skills.
• Ability to interact effectively with all organizational levels, including board and executive leadership.

Required Licensure/Certifications

• Preferred: HCCS, AAPC, or AHIMA credentials.

Additional Details

• Remote: Fully Remote
• Area of Interest: Professional/Management
• FTE/Hours: 1.00, 40 hours/week
• Shift: Day
• Job ID: 31315

Dartmouth Health is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status, and will not be discriminated against on the basis of disability. Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics comply with applicable federal civil rights laws and do not discriminate based on race, color, national origin, age, disability, or sex.