About this opportunity
Mental Health Cooperative lists this Compliance Auditor opportunity in nashville, Tennessee. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Compliance Auditor
The Compliance Auditor is responsible for conducting compliance auditing, monitoring, and risk assessment activities to ensure organizational adherence to federal, state, accreditation, contractual, and organizational requirements. This position evaluates clinical, billing, operational, and administrative functions to ensure compliance with regulations and standards established by the Office of Inspector General (OIG), Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Managed Care Organizations (MCOs), and other applicable regulatory authorities.
The Compliance Auditor identifies areas of regulatory risk, recommends corrective actions, evaluates the effectiveness of compliance controls, and supports continuous improvement efforts throughout the organization.
Essential Duties and Responsibilities
Compliance Auditing and Monitoring
Conduct routine and focused audits of clinical documentation, medical records, billing, coding, claims submission, service authorization, and operational processes.
Perform audits to ensure compliance with CMS, Medicaid, TennCare, TDMHSAS, TJC, OIG, and MCO requirements.
Evaluate documentation for medical necessity, treatment planning, service delivery, timeliness, and completeness.
Review provider credentialing and licensure compliance.
Assess adherence to organizational policies and procedures.
Develop audit work plans, audit tools, and monitoring methodologies.
Maintain audit schedules and ensure completion of annual compliance audit plans.
Risk Assessment and Analysis
Identify regulatory, operational, financial, and compliance risks across the organization.
Analyze audit findings to identify trends, root causes, and systemic issues.
Assist with annual compliance risk assessments.
Evaluate internal controls and compliance processes for effectiveness.
Recommend risk mitigation strategies and process improvements.
Corrective Action and Follow-Up
Prepare written audit reports detailing findings, observations, risks, and recommendations.
Collaborate with department leaders to develop corrective action plans.
Monitor implementation of corrective actions and validate effectiveness.
Conduct follow-up audits to ensure sustained compliance.
Track audit findings and compliance metrics.
Regulatory and Contractual Compliance
Monitor changes in federal and state healthcare regulations affecting behavioral health services.
Ensure compliance with:
OIG Compliance Program Guidance
CMS Medicaid and Medicare regulations
TJC accreditation standards
TDMHSAS licensing and contractual requirements
TennCare regulations
Managed Care Organization (MCO) contracts and policies
HIPAA Privacy and Security Rules
Fraud, Waste, and Abuse regulations
Survey and Audit Readiness
Assist departments in preparing for regulatory reviews, accreditation surveys, external audits, and site visits.
Participate in mock surveys and readiness assessments.
Review evidence and documentation requested by surveyors and auditors.
Support remediation activities resulting from external audits.
Reporting and Documentation
Maintain complete and accurate audit documentation and work papers.
Prepare reports for the Compliance Committee, Executive Leadership Team, and Board of Directors.
Track key audit indicators and organizational compliance trends.
Utilize compliance management software, spreadsheets, and reporting tools to monitor audit outcomes.
Education and Consultation
Provide guidance to operational and clinical staff regarding compliance requirements.
Educate departments on audit findings and regulatory expectations.
Assist with compliance training and awareness initiatives.
Serve as a compliance resource for managers and leadership.
Required Qualifications
Education
Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, Social Work, Behavioral Health, Accounting, or related field required.
Master's degree preferred.
Experience
Minimum of three (3) years of healthcare auditing, compliance, quality improvement, revenue cycle, or regulatory experience required.
Experience in behavioral health, community mental health, substance use treatment, or healthcare settings strongly preferred.
Experience auditing Medicaid-funded services preferred.
Preferred Certifications
Certified in Healthcare Compliance (CHC)
Certified Professional Medical Auditor (CPMA)
Certified Internal Auditor (CIA)
Certified Professional Coder (CPC)
Certified Healthcare Internal Audit Professional (CHIAP)
Knowledge, Skills, and Abilities
Regulatory Knowledge
Extensive knowledge of:
OIG Compliance Program Guidance
CMS regulations
Medicaid and TennCare requirements
TJC accreditation standards
TDMHSAS rules and regulations
MCO contractual requirements
HIPAA Privacy and Security Rules
Fraud, Waste, and Abuse prevention practices
Technical Skills
Medical record review and auditing
Data analysis and trend identification
Audit report writing
Risk assessment methodologies
Root cause analysis
Corrective action plan development
Proficiency with EHR systems and Microsoft Office applications
Professional Skills
Strong analytical and critical thinking abilities
Excellent verbal and written communication skills
High attention to detail
Ability to maintain confidentiality
Strong organizational and time-management skills
Ability to work independently and collaboratively
Work Environment
Primarily office environment.
Ability to travel between organizational sites as needed.
Ability to sit for extended periods while reviewing records and data.
Ability to access and review electronic health records and paper documentation.
Will require participation in regulatory surveys, audits, accreditation reviews, and compliance investigations.
Must maintain confidentiality and handle sensitive information appropriately.
BENEFITS: Mental Health Cooperative offers a full comprehensive benefit plan for you to participate in. The following products are available:
Medical Insurance/Prescription Drug Coverage
Health Savings Account
Dental & Vision Insurance
Basic Life and AD&D Insurance
Short- & Long-Term Disability
Supplemental Life Insurance
Cancer Insurance
Accident & Critical Illness Insurance
403b - Retirement Plan
Calm App for medication and mental health
Gym membership discounts
Pet Insurance
Paid Time Off
Mental Health Cooperative embraces inclusion, diversity and equal opportunity. We're committed to building a team that represents a variety of backgrounds, perspectives, and skills. Mental Health Cooperative is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.
Worksite address
nashville, TN, 37247, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.