Healthcare Compliance Auditor / Audit Practitioner Files

Healthcare Compliance Auditor / Audit Practitioner Files
Verify licensure, certifications, continuing education, and credentialing documents are current.
Check for regulatory compliance (e.g., CMS, Joint Commission, NCQA, state boards).
Monitor expiration dates and flag missing/incomplete documentation.

Collaborate with Development Teams:
Provide input on system improvements to automate compliance tracking.
Help streamline practitioner onboarding and file management through tech integration (e.g., EHR or HRIS).

Maintain Accurate Records:
Ensure centralized and organized documentation of practitioner files.
Implement version control and audit trails.

Provide Financial & Compliance Insights:
Identify potential compliance risks that may affect reimbursements or cause liabilities.
Offer data to inform workforce planning, budgeting, and reporting.

Ideal Qualifications
Background in healthcare compliance, HIM (Health Information Management), or medical auditing.

Familiarity with:
Credentialing platforms (e.g., CAQH, Echo, Modio)
Regulations like HIPAA, CMS, and OIG guidelines.
Proficient in tools like Excel, SQL, or EMR/HR systems.
Experience working with development/tech teams to optimize data flow.

May hold certifications like:
CHC (Certified in Healthcare Compliance)
CPMA (Certified Professional Medical Auditor)
RHIA (Registered Health Information Administrator)