Job Description
Summary The responsibilities of the Compliance Manager and Auditor include protecting the company's assets, enforcing compliance with internal regulations, recommending improvements to our internal control structure, and ensuring compliance with legal and federal regulations. A successful Compliance Manager and Auditor should have excellent attention to detail, analytical, and multitasking skills and be completely objective and possess an in-depth working knowledge of the operations and practices within our industry. Compliance Manager and Auditor will assist in the overall compliance and auditing activities to ensure compliance with standard operating procedures, corporate policies, industry standards, and applicable federal and state laws for Chesapeake Regional Healthcare (CRH). Reports to and works with the Chief Corporate Compliance Officer on compliance work plans, investigations, staff education, internal and external audits and reviews, and provides assurance that the CRH is operating in an efficient and effective manner. Compliance Manager and Auditor will provide an independent and objective assessment of CRH’s operations, specifically the effectiveness of its internal control structure. Essential Duties and Responsibilities These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned. Interpret and apply regulatory compliance and audit requirements across departments. Develop, review, and maintain compliance documentation and regulatory filings. Lead the creation, implementation, and ongoing review of policies and procedures aligned with laws and regulations. Design and deliver compliance training materials and communication tools. Conduct internal audits, regulatory exams, and compliance monitoring activities. Establish and manage self-audit and compliance monitoring programs. Coordinate and support external audits, including collaboration with auditors and regulatory agencies. Identify, assess, and mitigate compliance and operational risks across the organization. Investigate potential violations, track findings, and ensure appropriate corrective actions. Review business processes to safeguard against fraud, waste, and abuse; develop fraud detection tools. Analyze audit results and prepare reports and presentations for leadership and compliance committees. Partner with cross-functional teams (e.g., finance, clinical, revenue cycle) on compliance reviews and initiatives. Develop and monitor corrective action plans (CAPs), including follow-up audits to ensure effectiveness. Provide subject matter expertise and guidance to staff on compliance, billing, and documentation requirements. Ensure adherence to confidentiality standards, regulatory requirements, and organizational compliance program policies. Supervisory Responsibilities Reports to: Chief Corporate Compliance Officer Supervises: n/a Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and Experience Bachelor’s degree in business, accounting and/or healthcare administration in related field is required. Two years additional experience in healthcare compliance, audit, or revenue cycle experience may be considered in lieu of degree. Completion of relevant industry-specific certification, such as a certified internal auditor and certified in healthcare compliance preferred. Five years healthcare compliance, auditing or revenue cycle experience required. Experience with Diagnosis-Related Group (DRP), Current Procedural Terminology (CPT), Charge Description Master(CDM) Overall knowledge of hospital department operations. Knowledge of and experience with EPIC and Athena preferred. Strong Skills with Microsoft products (Excel, Word, and Power Point) Certificates, Licenses, Registrations: Health Care Compliance Association (HCCA) membership and certification preferred. Physical Demands & Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Separate sheet documenting description of physical demands and working conditions must be included/attac