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Compliance Auditor

2 months ago

Durham, North Carolina, United States Duke University Full time
Job Summary

Duke University is seeking a highly skilled Compliance Auditor to join our team. As a Compliance Auditor, you will be responsible for conducting health-system wide compliance audits to ensure data integrity, compliance with federal and state regulations, and accurate claims processing.

Key Responsibilities
  • Conduct clinical trial compliance audits, documenting and communicating findings and recommendations.
  • Manage activities related to monitoring requests and responses of governmental audits, monitor and trend activity, and oversee and monitor appeals.
  • Conduct risk assessments and prepare work plans.
  • Develop an understanding of the operations, system processes, and procedures used in areas being audited.
  • Review and test for compliance with institutional policies and procedures, applicable laws and regulations through the inspection of physical operations, processes, retrieval and review of documents, and investigation of irregularities and errors.
  • Compile information and/or prepare reports and analyses setting forth results of compliance audits with appropriate recommendations.
  • Develop recommended corrective actions to address issues detected.
  • Actively participate in exit conferences, providing clarification and supporting information necessary.
Requirements
  • Four years of experience related to legal, and regulatory compliance, patient advocacy, supervisory role in patient financial services or HIM services, or other relevant experience.
  • Experience with compliance auditing.
  • Experience independently performing and conducting compliance audits, including the review of documentation, coding, and billing.
  • Prefer experience in clinical research, familiarity with protocols, clinical trials, and clinical research studies.
  • Experience with Federal clinical research process and regulations, including billing, coding, and documentation requirements.
  • Demonstrated experience working as part of the interdisciplinary team.
  • Experience with EPIC and OnCore is preferred.
  • Research, abstracts, and communicates federal, state, and payor documentation, billing, and coding rules and regulations; stays current with Medicare and Medicaid rules and regulations, CPT, ICD, HCPCS, DRG, and APC coding updates related to clinical research and serves as a subject matter expert.
Preferred Qualifications
  • Coding certification (e.g. CPC, CCS, RHIA, or RHIT), Research compliance certification CHRC or applicable experience is required.
  • Ability to be flexible, multitask, and switch priorities as well as work comfortably in a deadline-driven/productivity environment.
  • Ability to prioritize, organize, plan, and implement services as well as handle multiple projects/problems simultaneously.
  • In-depth knowledge of federal regulations around clinical trials.
  • EPIC, OnCore, and Microsoft Office experience preferred.
About Duke University

Duke University is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas-an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes.