Senior Compliance Program Auditor

Role Description

The Senior Compliance Program Auditor will play a critical role in ensuring the accuracy, integrity, and compliance of the organization’s billing practices. This individual will execute audit projects, assess risks associated with billing, regulatory, and operational risk, and work closely with internal teams to implement corrective actions and improve processes.

• Assist with planning, fieldwork, and documentation of audits and reviews of laboratory revenue cycle operations to assess compliance with regulatory requirements.
• Analyze billing data and trends to detect and prevent fraud, waste, abuse, and potential coding issues through the use of data analytics.
• Conduct and document audits and reviews of third party vendors, international distributors, and interactions with HCPs/HCIs and other high-risk interactions to assess compliance with regulatory requirements and company policy.
• Work with other compliance and legal staff to investigate and resolve reported compliance concerns related to revenue cycle functions.
• Maintain awareness of the federal, state, and local regulatory environment related to the reimbursement of laboratory services to monitor relevance to the Exact Sciences’ Compliance Program.
• Identify potential weaknesses in revenue cycle functions and activities and proactively suggest improvements to address them.
• Lead walkthroughs, document narratives, and test assigned processes and controls for Exact Sciences’ laboratory entities to ensure compliance with all policies, procedures, and processes.
• Prepare internal audit reports, participate in close meetings, and present summaries internally.
• Make process improvement suggestions to company management based on audit results.
• Follow up on outstanding compliance issues from previous audits.
• Liaise with external auditors including, but not limited to, documentation, testing, coordination, and follow ups related to findings, as needed.
• Utilize interdepartmental collaboration skills to engage across teams.
• Ability to analyze processes and determine if adequate controls are in place and appropriate for the related activity.
• Ability to take direction and independently work towards achievement of projects.
• Ability to articulate complex information into understandable terms and effectively communicate at all levels within an organization.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the company’s Quality Management System policies and procedures.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work designated schedule.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability to work on a computer and phone simultaneously.
• Ability to use a telephone through a headset.
• Ability to travel 25% of working time away from work location, may include overnight/weekend travel.

Qualifications

• Bachelor’s degree in Accounting, Finance, Healthcare Administration, or a related field as outlined in the essential duties.
• 3+ years of experience in a role requiring adherence to process, internal controls, or internal/external audit experience.
• Demonstrated ability to execute auditing activities.
• Strong written and oral communication skills.
• Knowledge of the health care industry, including experience in auditing compliance with the requirements of AdvaMed, FCPA, AKS, FCA, etc.
• Knowledge of Federal, State and local health care laws and regulations, as well as applicable regulatory agencies.
• Ability to work both independently and collaboratively with cross-functional teams.
• Strong analytical skills with the ability to interpret complex data sets and regulations.
• Advanced skills in Microsoft Office (Specifically Word, PowerPoint, Excel).
• Demonstrated ability to perform the essential duties of the position with or without accommodation.
• Authorization to work in the United States without sponsorship.

Preferred Qualifications

• Public accounting experience.
• Advanced knowledge with data analytics platforms (Tableau or PowerBI).
• Familiarity with the regulatory framework governing healthcare billing, including the Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), and payer-specific guidelines.
• Certified Public Accountant (CPA) or Certified Internal Auditor (CIA) designation.

Benefits

• Paid time off (including days for vacation, holidays, volunteering, and personal time).
• Paid leave for parents and caregivers.
• Retirement savings plan.
• Wellness support.
• Health benefits including medical, prescription drug, dental, and vision coverage.