Compliance Audit Specialist Job at MMM Holdings
LE0002 MMM Holdings, LLC
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Responsible for auditing internal departments and contract vendors, to assure compliance with CMS standards and company’s policies and procedures. Coordinates trainings and research of internal and external investigations conducted by the Compliance Management. Implement and maintain Compliance programs in accordance with the Office of Inspector General’s work plan, to reduce legal and financial risk through education and internal audits including assisting the Chief Compliance Officer or his/her designee in establishing standards, policies and procedures.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Schedules and performs on-site and desk review investigations to determine compliance and investigate violations to CMS standards and regulations. Ensure that revisions to department policies and procedures are updated annually and are on the intranet in a timely manner. Audits internal departments and contracted vendors. Assists in coordinating company trainings. Prepares weekly, quarterly, semi-annual, and special reports to management. Researches, interprets, and enforces various sources of regulatory documentation. Performs analysis of current situations and recommends priorities and goals for future needs. Identifies coding and billings risk areas, conducts focused reviews, and ensures the implementation of corrective actions as needed. Collaborates with the Management, and department directors in establishing standards, policies and procedures that are compliant with CMS requirements and regulations. Assists in maintaining internal policies electronically.
Education and Training
Develop, and implement trainings as needed in the company. Conduct Compliance, Fraud Waste and Abuse and HIPAA trainings to new employees. Conduct focused trainings upon identified needs for departments and individuals. Assist in helping internal and external Customers. Provide guidance to internal and external customers regarding compliance, fraud, waste, and abuse issues based on established policies and procedures and his/her judgment.
Audit and Investigation
Schedule and conduct audits for MMM Healthcare, LLC departments and/or delegated entities according to CMS standards and company policies and procedures. Investigate, respond, and make decisions regarding the inquiries from internal departments and delegated entities regarding compliance issues. Conduct and document investigations according to established policies and procedures in response to reports received on the confidential help line, through the confidential fax, via email or person, Sales and Marketing complaints received through the CMS Complaints Tracking Module or in the Appeals and Grievances Department. If necessary, the Specialist can complete the investigation and determine the resolution based on his/her knowledge and judgment.
Marketing Materials
Receive, review, analyze and revise draft documents and communicate with MMM departments regarding necessary changes to assure Communications and/or Marketing Materials are developed in accordance to CMS and ASES regulations and requirements. Document the review and approval process for each document in the Compliance Log. Assure that Materials are correctly written and/or translated. Report the status of pending submissions and status of the inventory to the Compliance Management weekly. Maintain complete, accurate and timely material files and document on the public drive. Serve as a liaison with CMS and ASES Reviewers for all issues related to Materials. Investigate and respond to inquiries from internal departments and delegated entities on marketing and communication materials issues.
Others
Perform any other task or duty as requested and necessary to the organization’s accomplishment of its goals and objectives.
EDUCATION AND EXPERIENCE
- Minimum a bachelor’s degree in healthcare administration or business-related field from four-year College or university. Master’s Degree is preferred
- Three to Five years related experience and/or training; or equivalent combination of education and experience.
LANGUAGE SKILLS
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence.
- Ability to speak effectively before groups of customers or employees of the organization.
- Word processing skills must be proficient and accurate with knowledge of grammar, spelling and punctuation in English.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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