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

Jan 30, 2020 / 6 Minutes Read / By Albert

How to Become

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The senior health care compliance auditor is responsible for ensuring that the health care facilities are compliant with regulations and laws. This role plays an important part in promoting the safety of the public and protecting patient rights. By carrying out audits, the compliance auditor can identify any non-compliance issues and recommend corrective measures.

This helps to reduce the risk of severe penalties, financial losses, and reputational damage which can be caused by non-compliance. it can help to ensure that the health care facility is providing quality services and meeting the standards set by the government or regulatory bodies.

Steps How to Become

Obtain a Bachelor's Degree. A Bachelor's degree in healthcare administration, finance, accounting, or a related field is typically required to become a Senior Health Care Compliance Auditor.
Gain Professional Experience. Many employers require at least three to five years of professional experience in the healthcare industry in order to qualify for a senior health care compliance auditor position.
Earn Relevant Certifications. There are a number of professional certifications that are beneficial for those seeking a senior health care compliance auditor position. These include Certified Professional Compliance Officer (CPCO), Certified Healthcare Compliance Professional (CHCP), and Certified Professional in Healthcare Quality (CPHQ).
Develop Skills and Knowledge. Senior health care compliance auditors must possess strong analytical, organizational and problem-solving skills. They must also understand the legal and regulatory requirements that govern the healthcare industry.
Pursue Advanced Degrees. Pursuing an advanced degree such as a Master's in Healthcare Administration or a related field may be beneficial for those seeking a senior health care compliance auditor position.

Staying ahead and competent in the field of health care compliance auditing requires a great deal of diligence, knowledge and experience. As laws and regulations change, auditors must be able to adapt to the changes as well as any new processes and procedures. Health care organizations must remain vigilant in monitoring their compliance and auditors must be able to identify any potential risks or issues.

In addition, auditors must understand the industrys best practices in order to provide effective advice and guidance to health care organizations. Finally, auditors must stay up-to-date with the latest technologies and trends in order to be able to use them effectively when needed. This combination of knowledge and experience will help auditors stay ahead and competent in the field of health care compliance auditing.

You may want to check Senior Tax Auditor, Senior Information Systems Auditor, and Human Resources Auditor for alternative.

Job Description

Develop and implement policies and procedures to ensure compliance with all applicable federal, state, and local regulations related to health care.
Monitor health care services and activities to ensure compliance with regulations.
Review employee files and records to ensure compliance with laws, regulations, and policies.
Prepare reports of findings and recommendations for corrective action.
Develop training programs for staff on health care compliance issues.
Collaborate with other departments to ensure that compliance requirements are met.
Audit claims and other financial documents to ensure accuracy and compliance.
Stay informed of current health care regulations and trends.
Liaise with external regulatory bodies to ensure compliance with all applicable laws and regulations.
Provide advice on best practices for health care compliance.

Skills and Competencies to Have

Knowledge of relevant federal and state health care laws, regulations, and guidelines.
Understanding of HIPAA, Medicare, and Medicaid requirements.
Experience in auditing, monitoring, and evaluating health care systems for compliance.
Ability to document and report compliance findings.
Excellent analytical and problem-solving skills.
Strong communication and interpersonal skills.
Proficient in MS Office Suite (Word, Excel, and PowerPoint).
Ability to work independently, as well as part of a team.
Knowledgeable of internal control processes and procedures.
Detail-oriented and organized approach to work.

The ability to analyze complex data and identify potential health care compliance issues is essential for a successful Senior Health Care Compliance Auditor. A solid understanding of the regulations and laws related to health care compliance is also key, as well as knowledge of the relevant state and federal laws. a Senior Health Care Compliance Auditor must possess strong organizational, communication, and problem-solving skills.

Good judgment and critical thinking capabilities are necessary to ensure that the organization is compliant with all regulations and to develop effective strategies for addressing compliance issues. An auditor must also be able to work collaboratively with stakeholders, such as government agencies and insurance companies, to ensure the organization is meeting their expectations. Finally, an auditor must have the ability to stay up-to-date on changes to laws and regulations and be able to quickly assess the potential impact of those changes on the organization.

Tax Auditor, IT Auditor, and Forensic Accounting Auditor are related jobs you may like.

Frequent Interview Questions

What experience do you have with health care compliance audits?
How do you stay up to date on changes in the field of health care compliance?
How do you develop audit plans to identify areas of non-compliance?
What strategies do you use to ensure that the data collected during an audit is accurate and complete?
Describe a successful audit outcome you have achieved in the past.
How do you identify and prioritize areas of risk within a health care compliance audit?
What challenges have you faced while conducting health care compliance audits?
How do you handle situations in which your audit results are not accepted by management?
What methods do you use to ensure the confidentiality of patient information during an audit?
Describe the most complex health care compliance issue that you have had to address.

Common Tools in Industry

HIPAA Audit Tool. This tool is used to audit and assess an organization's compliance with HIPAA regulations. Example: Nymity Compliance Auditor.
Data Security Auditing Tool. This tool helps to audit and monitor data security systems to ensure they are up to date and compliant. Example: Splunk Enterprise Security.
Risk Analysis Tools. These tools provide the ability to identify, assess, and manage potential risks. Example: Riskonnect Risk Analysis.
Compliance Monitoring Software. This type of software helps organizations ensure compliance with applicable laws and regulations. Example: AuditBoard Compliance Monitor.
Reporting Tools. These tools provide reporting capabilities to analyze and monitor compliance activities. Example: LogicManager Compliance Reporting.

Professional Organizations to Know

American Health Care Association
National Association of Healthcare Quality
American Society for Healthcare Risk Management
Healthcare Compliance Association
American Association of Nurse Attorneys
Health Care Compliance Association
American Society for Healthcare Quality
American Hospital Association
American Medical Association
Joint Commission on Accreditation of Healthcare Organizations

We also have Payroll Auditor, Corporate Auditor, and Information Security Auditor jobs reports.

Common Important Terms

HIPAA. The Health Insurance Portability and Accountability Act, which is a federal law that establishes national standards to protect the confidentiality and security of protected health information.
Health Care Fraud. Illegal activities that are intended to defraud health care programs or providers out of money or property.
Compliance Auditing. The systematic review of an organizations policies, procedures, and activities to ensure that they are in accordance with legal and regulatory requirements.
Risk-Based Auditing. An audit approach that focuses on areas of higher potential risk and is tailored to the organizations operations, size, complexity, and other factors.
CMS. The Centers for Medicare & Medicaid Services, which is a federal agency that administers the Medicare, Medicaid, and Childrens Health Insurance Programs.
OIG. The Office of Inspector General, which is an independent agency within the US Department of Health & Human Services that is responsible for fighting fraud, waste, and abuse in government health care programs.
Fraud & Abuse. Illegal activities related to the delivery of health care services, such as billing for services not rendered or for higher levels of service than actually provided.
Anti-Kickback Statute. A federal law that prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by federal health care programs.

Frequently Asked Questions

Q1: What is a Senior Health Care Compliance Auditor? A1: A Senior Health Care Compliance Auditor is a specialist responsible for ensuring that health care organizations comply with applicable laws and regulations. They review the organization's policies and procedures, inspect records, and audit financial and operational activities to ensure compliance. Q2: What qualifications are required to become a Senior Health Care Compliance Auditor? A2: To become a Senior Health Care Compliance Auditor, individuals must typically possess a bachelor's degree in accounting, healthcare administration, or a related field. In addition, experience in auditing or compliance is often required. Q3: What are the duties of a Senior Health Care Compliance Auditor? A3: The duties of a Senior Health Care Compliance Auditor include assessing the organization's operations to identify compliance risks, evaluating internal controls to assess their effectiveness, conducting audits to verify financial accuracy, and recommending corrective actions in the event of any discrepancies or discrepancies. Q4: What types of entities are subject to health care compliance auditing? A4: Health care compliance auditing applies to all health care organizations, including hospitals, nursing homes, doctors' offices, clinics, laboratories, and other health care providers. Q5: What is the average salary of a Senior Health Care Compliance Auditor? A5: The average salary of a Senior Health Care Compliance Auditor can vary depending on experience and location. According to PayScale, the median annual salary for a Senior Health Care Compliance Auditor is $69,735 as of May 2020.