Healthcare Compliance Auditor Job Description [Updated for 2025]

In an era of increasing healthcare regulations, the need for healthcare compliance auditors has never been greater.

As the healthcare industry evolves, the demand for skilled professionals who can navigate, enforce, and safeguard our compliance standards amplifies.

But what’s really expected from a healthcare compliance auditor?

Whether you are:

• A job seeker trying to understand the essence of this role,
• A hiring manager outlining the perfect candidate,
• Or simply curious about the intricacies of healthcare compliance auditing,

You’ve come to the right place.

Today, we present a customizable healthcare compliance auditor job description template, designed for effortless posting on job boards or career sites.

Let’s dive right into it.

Healthcare Compliance Auditor Duties and Responsibilities

Healthcare Compliance Auditors play a vital role in the healthcare sector.

They ensure that healthcare organizations adhere to established regulations and standards.

Their primary function is to examine and improve compliance programs within healthcare institutions.

Their duties and responsibilities include:

• Reviewing and analyzing medical records and billing documentation to ensure accuracy
• Auditing healthcare providers’ compliance with federal, state, and local regulations and standards
• Identifying compliance issues and developing action plans to prevent or resolve them
• Preparing and presenting reports on audit findings and recommendations to management
• Providing training and guidance to staff on compliance-related matters
• Staying updated on changes in healthcare laws, regulations, and standards
• Assisting in the development and implementation of compliance policies and procedures
• Working with management to ensure corrective actions are taken in response to audit findings
• Conducting risk assessments and implementing strategies to mitigate identified risks

 

Healthcare Compliance Auditor Job Description Template

Job Brief

We are seeking a detail-oriented Healthcare Compliance Auditor to ensure our healthcare organization adheres to legal standards and in-house policies.

The responsibilities of the Healthcare Compliance Auditor include enforcing regulations in all aspects of the business, providing guidance on compliance matters, and facilitating proactive audits that identify and mitigate compliance risk.

Our ideal candidate has a deep knowledge of industry laws and regulations.

They should be comfortable handling confidential information and be highly ethical.

 

Responsibilities

• Plan, implement and oversee risk-related programs.
• Conduct regular audits to ensure compliance and identify potential compliance risks.
• Create sound internal controls and monitor adherence to them.
• Draft, modify and implement company policies.
• Proactively audit processes, practices and documents to identify weaknesses.
• Educate and train employees on regulations and industry practices.
• Collaborate with external auditors and HR when needed.
• Set plans to manage a crisis or compliance violation.
• Keep abreast of internal standards and business goals.
• Ensure all employees are educated on the latest regulations and processes.

 

Qualifications

• Proven experience as a Compliance Officer or Compliance Manager.
• Experience in a healthcare environment preferred.
• Knowledge of legal requirements and controls (e.g. Anti-Money Laundering, or AML).
• Familiarity with industry practices and professional standards.
• Excellent communication skills.
• Integrity and professional ethics.
• Business acumen.
• Teamwork skills.
• Attention to detail.
• Bachelor’s degree in Law, Business Administration or related field.

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Healthcare Compliance Auditor
• Work Environment: Office setting with options for remote work. Some travel may be required for audits or meetings.
• Reporting Structure: Reports to the Compliance Officer or Compliance Manager.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $63,000 minimum to $105,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Healthcare Compliance Auditor Do?

Healthcare Compliance Auditors typically work for healthcare facilities, insurance companies or government agencies to ensure that healthcare providers are in compliance with the regulations and standards of the healthcare industry.

Their main task is to perform audits on healthcare organizations to inspect and evaluate their compliance with laws, regulations, and policies.

This includes reviewing patient records, billing practices, and procedural documentation to ensure adherence to privacy laws and billing regulations.

They also conduct interviews with employees and management to gain insight into organizational processes and to identify potential areas of non-compliance.

They may then draft reports detailing their findings and suggesting recommendations for improvements.

Healthcare Compliance Auditors are often responsible for staying up to date with changes in healthcare legislation and adjusting their audit protocols accordingly.

They may also provide training and guidance to healthcare staff on compliance matters to prevent future breaches.

In addition, these professionals may also be involved in investigating complaints or reports of non-compliance, and they work closely with legal and management teams to resolve these issues effectively and promptly.

 

Healthcare Compliance Auditor Qualifications and Skills

A healthcare compliance auditor should possess a range of technical abilities, soft skills, and industry knowledge to ensure compliance with healthcare regulations, including:

• Knowledge in health care regulations, including state and federal regulatory requirements, to efficiently perform audits and ensure compliance.
• Analytical skills to assess, evaluate and monitor healthcare compliance programs and identify any areas of risk or non-compliance.
• Excellent communication skills to clearly explain findings from audits to management, healthcare providers, and other stakeholders and provide recommendations for corrective action.
• Attention to detail to thoroughly review healthcare records, procedures, and practices, ensuring all details align with compliance regulations.
• Interpersonal skills to effectively work with a variety of healthcare professionals and staff members, fostering a team approach to compliance.
• Problem-solving skills to address any compliance issues that arise and devise effective solutions to ensure regulatory adherence.
• Proficiency in using compliance software and other IT systems to streamline audit processes and maintain accurate records.
• Ability to stay updated with changes in healthcare regulations and standards, applying this knowledge to enhance the effectiveness of compliance programs.

 

Healthcare Compliance Auditor Experience Requirements

Healthcare Compliance Auditors typically need a minimum of a bachelor’s degree in a related field such as healthcare administration, finance, or accounting.

Most employers also prefer candidates with at least 3 to 5 years of experience in healthcare compliance, risk management, or auditing.

Entry-level candidates may gain experience in roles such as Compliance Analyst or Compliance Assistant.

This often involves assisting in developing and maintaining an organization’s compliance program, performing compliance audits, and providing compliance training to staff.

Candidates with more than 3 years of experience often have a more in-depth understanding of healthcare laws, regulations, and standards.

They may have developed their skills and knowledge in roles such as Compliance Officer or Compliance Specialist.

They are usually capable of developing and implementing compliance programs, conducting detailed compliance audits, and reporting their findings to management.

Those with more than 5 years of experience often have some leadership experience and may be ready for senior roles such as Senior Compliance Auditor or Compliance Manager.

These professionals not only perform audits but also play a crucial role in strategic decision-making, risk management, and ensuring that the organization maintains its compliance with all relevant regulations and standards.

Also, most healthcare compliance auditor positions require certification from a recognized professional body, such as the Certified in Healthcare Compliance (CHC) credential offered by the Health Care Compliance Association (HCCA).

 

Healthcare Compliance Auditor Education and Training Requirements

Healthcare Compliance Auditors typically require a bachelor’s degree in health administration, nursing, or a related field.

In some cases, a degree in business administration or finance can also be relevant, especially if complemented with experience or education in the healthcare sector.

They also need a strong background in healthcare regulations and legal guidelines, as well as a solid understanding of medical coding, billing, and healthcare operations.

Knowledge of Health Insurance Portability and Accountability Act (HIPAA) and other healthcare laws is critical.

Many positions require Healthcare Compliance Auditors to have a Certified Professional in Healthcare Quality (CPHQ), Certified in Healthcare Compliance (CHC), or a similar certification.

These certifications demonstrate a sound understanding of healthcare quality management and regulatory compliance, which are critical to this role.

Some positions, especially in larger organizations or those with significant compliance risks, may require Healthcare Compliance Auditors to have a master’s degree in health administration, law, business administration, or a related field.

Continuing education is also important in this role due to the constantly changing nature of healthcare regulations and practices.

Therefore, professionals in this role often participate in ongoing training and professional development opportunities.

 

Healthcare Compliance Auditor Salary Expectations

A Healthcare Compliance Auditor earns an average salary of $71,982 (USD) per year.

However, the actual earnings can vary based on the level of experience, education, certifications, and the location of the job.

Some other factors that can influence the salary include the size of the healthcare organization and the complexity of compliance needs.

 

Healthcare Compliance Auditor Job Description FAQs

What skills does a Healthcare Compliance Auditor need?

Healthcare Compliance Auditors need to have strong analytical skills to understand and apply regulations and laws to various healthcare situations.

They also need to have a keen attention to detail to identify any compliance issues or discrepancies in data.

Good communication and interpersonal skills are also essential as they will often have to explain complex regulations and potential violations to healthcare providers.

 

Do Healthcare Compliance Auditors require a specific degree or certification?

While it’s not always required, many Healthcare Compliance Auditors hold a degree in Healthcare Administration, Law, or a related field.

Additionally, certifications such as Certified in Healthcare Compliance (CHC) or Certified Healthcare Internal Auditor (CHIA) can enhance their credibility and demonstrate their expertise in the field.

 

What should you look for in a Healthcare Compliance Auditor resume?

In addition to educational qualifications and certifications, you should look for experience in healthcare compliance or auditing.

This could include experience with healthcare laws and regulations, reviewing medical records, or conducting audits in healthcare settings.

Knowledge of healthcare coding systems like ICD-10 can also be beneficial.

 

What qualities make a good Healthcare Compliance Auditor?

A good Healthcare Compliance Auditor is meticulous and detail-oriented, ensuring that all aspects of an organization’s operations comply with laws and regulations.

They must be knowledgeable about current healthcare regulations and have the ability to interpret these regulations in the context of the organization’s operations.

Good communication skills are also essential, as they must effectively communicate complex compliance information to various stakeholders.

 

Is it challenging to hire a Healthcare Compliance Auditor?

Hiring a Healthcare Compliance Auditor can be challenging due to the specialized nature of the role.

It requires a combination of knowledge in healthcare, regulations, and auditing, which may not be readily available in many candidates.

Therefore, it is crucial to offer competitive compensation and career development opportunities to attract and retain qualified Healthcare Compliance Auditors.

 

Conclusion

And there we have it.

We’ve just unraveled the true essence of being a healthcare compliance auditor.

Surprise, surprise?

It’s not merely about checking boxes and following rules.

It’s about ensuring health and safety, one audit at a time.

Leverage our tailor-made healthcare compliance auditor job description template and real-world examples, and you’re ready to make your move.

But why not go further?

Dig deeper with our job description generator. It’s your next step to creating precise job listings or refining your resume to perfection.

Remember:

Every audit is a step towards a healthier, safer world.

Let’s make that world. Together.

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