How to Be Health Care Compliance Auditor - Job Description, Skills, and Interview Questions

Health care compliance auditors play an important role in ensuring that medical facilities adhere to applicable laws, regulations, and standards. By examining medical records, billing practices, and other documents, they identify areas of non-compliance that can lead to costly fines and sanctions. In addition, they work to ensure that patient rights are respected, data is secure, and the facility's overall operations are ethical. Their efforts help create a safe and effective healthcare environment, which in turn helps improve the quality of patient care.

Steps How to Become

1. Obtain a college degree. Health care compliance auditors must have a minimum of a bachelor’s degree in an area such as accounting, finance, healthcare administration or business.
2. Pursue relevant work experience. Many employers prefer to hire compliance auditors who have at least two to three years of experience in the healthcare field, such as working as a medical billing specialist or in a related position.
3. Earn certifications. Certification is not always required, but it can be beneficial to become certified as a professional compliance auditor. The Health Care Compliance Association (HCCA) offers several certifications in the field, such as the Certified Compliance & Ethics Professional (CCEP) and Certified Healthcare Compliance Auditor (CHCA).
4. Obtain a license. Depending on the state you live in, you may need to obtain a license to become a healthcare compliance auditor. This typically involves completing an application and passing a licensing exam.
5. Keep up with changes. Healthcare compliance auditing is an evolving field, so it’s important for auditors to stay up to date on the latest regulations and laws. Auditors should also look for continuing education opportunities to stay current on their skills and knowledge.

Health Care Compliance Auditors are essential to ensure that health care organizations comply with applicable laws and regulations. Becoming a skilled and efficient Health Care Compliance Auditor requires an understanding of healthcare regulations, an eye for detail, and the ability to think critically. With these skills, Health Care Compliance Auditors can identify potential compliance issues, create and implement effective procedures for addressing them, and ensure that health care organizations remain compliant.

Furthermore, effective communication and collaboration between the auditor and the organization is necessary to effectively ensure compliance. When these skills are developed, Health Care Compliance Auditors can be instrumental in keeping healthcare organizations compliant and can help to ensure that patient safety is not compromised.

You may want to check Tax Auditor, Compliance Monitoring Auditor, and Government Auditor for alternative.

Job Description

1. Design and implement health care compliance audit plans.
2. Conduct detailed audits to assess compliance with applicable laws and regulations including HIPAA, the Affordable Care Act, and other health care reforms.
3. Review and analyze data related to compliance issues.
4. Identify areas of non-compliance and recommend corrective action.
5. Develop and implement policies, procedures, and training programs to ensure compliance.
6. Monitor changes in laws and regulations to ensure compliance with the latest standards.
7. Research and interpret legal regulations related to health care compliance.
8. Prepare detailed reports of audit findings and recommendations for management.
9. Communicate audit findings to management and other stakeholders.
10. Provide ongoing support to ensure compliance is maintained.

Skills and Competencies to Have

1. Knowledge of health care regulatory requirements, compliance laws and best practices.
2. Understanding of accounting principles, auditing and investigative techniques.
3. Expertise in data analysis and data mining with the ability to interpret complex information.
4. Strong research, investigative and problem-solving skills.
5. Excellent written and verbal communication skills.
6. Ability to maintain confidentiality of sensitive information.
7. Good organizational skills and attention to detail.
8. Proficiency in Microsoft Office Suite and other relevant software programs.
9. Ability to work independently and as part of a team.
10. Ability to develop and maintain relationships with clients and colleagues.

Health Care Compliance Auditors are responsible for ensuring that a health care organization is following all applicable laws and regulations. This is a very important role that requires a combination of knowledge, skills, and experience. The most important skill for a Health Care Compliance Auditor is their ability to understand and interpret complex laws and regulations in order to identify any potential compliance issues.

it is essential for them to be able to identify areas where the organization needs to improve their compliance procedures and develop strategies to mitigate risk. It is also necessary for Health Care Compliance Auditors to have excellent communication skills in order to be able to explain the compliance issues to the organization’s leadership and work with the organization to develop solutions. Furthermore, they must have strong analytical and problem-solving skills in order to identify potential issues and develop actionable solutions.

Finally, they must have the ability to stay organized, as they will often have multiple projects going on at once and need to be able to keep track of all of them. The combination of these skills is necessary for Health Care Compliance Auditors to effectively assess the compliance of health care organizations.

Human Resources Auditor, Data Quality Auditor, and Operational Auditor are related jobs you may like.

Frequent Interview Questions

• How would you go about developing a risk assessment process?
• Describe a compliance audit that you have performed.
• What experience do you have with developing and implementing policies and procedures?
• What challenges have you faced in health care compliance auditing?
• How would you go about identifying potential compliance issues?
• How do you ensure that your audit results are accurate?
• How have you acted on the results of a health care compliance audit?
• What experience do you have with healthcare regulations?
• Describe a time when you identified a compliance issue that had not been previously identified.
• How do you stay up to date on recent changes in applicable laws and regulations?

Common Tools in Industry

1. Internal Compliance Audit Software. This software helps healthcare organizations assess and monitor compliance with applicable laws and regulations. (e. g. Meditrak Compliance Auditor)
2. HIPAA Security Risk Analysis Tool. This tool helps organizations identify and reduce risks associated with HIPAA compliance. (e. g. SecureLink Risk Manager)
3. Compliance Training Platform. This platform offers online courses and resources to help healthcare organizations stay compliant and up-to-date on the latest regulations. (e. g. Compliance Pro Solutions)
4. Internal Audit Management Software. This software facilitates the management and tracking of internal compliance audits. (e. g. Compliance Manager Pro)
5. Data Governance Platform. This platform helps healthcare organizations organize and manage their data to ensure compliance with regulatory requirements. (e. g. Data360 Governance Suite)

Professional Organizations to Know

1. American Health Information Management Association (AHIMA)
2. Health Care Compliance Association (HCCA)
3. International Association of Healthcare Internal Auditors (IAHIA)
4. American Institute of Certified Public Accountants (AICPA)
5. Association of Certified Fraud Examiners (ACFE)
6. National Association of Healthcare Revenue Integrity (NAHRI)
7. Society of Corporate Compliance and Ethics (SCCE)
8. Healthcare Financial Management Association (HFMA)
9. American Bar Association Health Law Section (ABA-HLS)
10. American Society for Healthcare Risk Management (ASHRM)

We also have Senior Operational Risk Management Auditor, Corporate Auditor, and Systems Auditor jobs reports.

Common Important Terms

1. HIPAA (Health Insurance Portability and Accountability Act). Federal legislation that protects the privacy of an individual's health information, including records and data.
2. False Claims Act. Federal law that prohibits individuals or organizations from knowingly submitting false claims for payment or reimbursement to the government.
3. Office of Inspector General (OIG). An agency within the U. S. Department of Health and Human Services (HHS) that works with other federal agencies to protect the integrity of HHS programs, including Medicare and Medicaid.
4. CMS (Centers for Medicare & Medicaid Services). A federal agency that administers the Medicare and Medicaid programs, as well as other health-related programs.
5. EMTALA (Emergency Medical Treatment and Active Labor Act). Federal law that requires hospitals to provide emergency medical care to patients regardless of their ability to pay.
6. Stark Law. Federal law that prohibits physicians from referring Medicare and Medicaid patients to providers in which the physician or an immediate family member has a financial interest.
7. Anti-Kickback Statute. A federal law that prohibits the exchange or offer of any form of remuneration in order to induce referrals for services that are paid for by federal health care programs.

Frequently Asked Questions

What is a Health Care Compliance Auditor?

A Health Care Compliance Auditor is a professional who ensures that health care organizations and providers comply with applicable laws, regulations, and standards.

What qualifications are needed to be a Health Care Compliance Auditor?

Health Care Compliance Auditors typically need a bachelor's degree in accounting, finance, or a related field, as well as experience in an internal audit, compliance, or healthcare setting.

What tasks does a Health Care Compliance Auditor typically perform?

Health Care Compliance Auditors typically perform risk assessments, audit plans, and review financial statements to ensure legal and ethical compliance. They may also review operational processes, evaluate policy and procedure effectiveness, and recommend corrective actions.

What type of organizations employ Health Care Compliance Auditors?

Health Care Compliance Auditors are typically employed by hospitals, health care systems, health insurance companies, and other health care organizations.

What type of reports do Health Care Compliance Auditors prepare?

Health Care Compliance Auditors typically prepare detailed compliance reports that include their findings and recommendations for corrective actions.

What are jobs related with Health Care Compliance Auditor?

• Senior Tax Auditor
• Payroll Auditor
• External Auditor
• Compliance Auditor
• Senior Government Contract Compliance Auditor
• Information Security Auditor
• Revenue Cycle Management Auditor
• Staff Auditor
• IT Auditor
• Forensic Accounting Auditor

Web Resources

• Healthcare Compliance: Everything You Need to Know - University of P… www.phoenix.edu
• Healthcare Compliance Policy - USC Office of Culture, Ethics and Comp… ooc.usc.edu
• Health Care Compliance Certificate | USC Online - The online … online.usc.edu