Compliance Auditor

Job description

Ranked one of Tennessee’s top places to work, MHC is a rare and special place where outstanding company culture is intentional. Where clients and associates are treated the same, as equals. Mental Health Cooperative, Inc. (MHC) was formed in 1993 to serve individuals with severe and persistent mental illness. Since then, we have expanded our services to children and adolescents with severe emotional disorders across Middle and East Tennessee. Our sole purpose is to support and treat those challenged with serious mental illness and poverty. Although based out of Nashville, we serve several communities across middle and East Tennessee with satellite offices in Antioch, Gallatin, Dickson, Columbia, Cleveland, Murfreesboro, Clarksville, Cookeville, Chattanooga, and Memphis. If you are interested in joining a team that is caring, collaborative, innovative and energizing this might be a great place for you! Job Title: Compliance Auditor Department: Compliance Reports To: Director of Compliance, VP of Compliance Location: On-site FLSA Status: Exempt Purpose: 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. Position Summary: 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 One or more of the following certifications preferred: 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.