Audit and Compliance Specialist

 

About Us:

Arizona Liver Health (ALH) is dedicated to driving high standards of care and advancing medical innovation through leading clinical trials, ensuring patient safety and regulatory compliance, and generating high-quality clinical data. Our network of multiphase, multitherapeutic research, standard of care, and VEN Centers sites is staffed by skilled providers, research, clinic, pharmacy, and patient outreach professionals. ALH operates state-of-the-art facilities and programs to meet the evolving needs of clinical research and overall patient treatment.

 

Job Summary:

Arizona Liver Health team is searching for qualified candidates to fill the Audit and Compliance Specialist position in Mesa, AZ. 

Job Title: Audit and Compliance Specialist

Location: Onsite (Mesa)

Reports To: ​Associate Director of 340B Pharmacy

Compensation: $75,000 - $95,000, depending on experience and qualifications

Status: Full-time, Salary, Exempt

Essential job functions/duties

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

• Maintains deep understanding of all ALH workflow systems and operations, including medical, outreach, and 340B.
• Auditing, presenting, and resolving compliance issues as they arise, while monitoring and tracking on a regular basis.
• Report data trends that are discovered through reconciliation to key stakeholders.
• Develop a thorough understanding of compliance functions for each department and ensure requirements are met.
• Serves as liaison between ALH and any other constituent, where a contract relationship exists.  Monitors, reports, and analyzes contracts; provides financial reports to leadership relative to financial impact and liabilities; makes recommendations that would improve efficiency.
• Work directly with prior authorization, outreach, and medical teams to help facilitate and maximize the capture of referral claims and ensure compliance on all claims.
• Partner with compliance teams in each department to ensure alignment with front end and back end processing workflow, audit and troubleshoot processes as needed.
• Act as liaison with ALH staff to understand cross-functional impact of actions over multiple departments.  Train and educate staff regarding standards for compliance.
• Establish standardized process for reporting any additions, changes and accuracy of all relevant documentation.
• Develop reports that can be used to educate staff and assist management in tracking the overall financial impact to the organization.
• Build other reports, as appropriate, to monitor and improve program compliance and performance.
• Perform special assignments and other work, on an as-needed basis.

Supervisory responsibilities

• None

Work environment

• Office/Clinic setting

Knowledge/Skills/Abilities Required

• Ability to work cooperatively with staff to meet departmental objectives. Knowledge of management software solutions and electronic health records is preferred.
• Ability to communicate effectively to deal with conflicting views or issues, including well-developed writing skills and appropriately articulating concepts or ideas in a constructive manner.
• Experience and skill with spreadsheets and other accounting applications (Excel, Lotus, Access, PowerPoint) with advanced proficiency in data analytics and reporting tools (e.g. pivot tables, VLOOKUP/XLOOKUP, and data visualization)
• Proven ability to reconcile complex billing, prior authorization, and referral claims data to identify potential compliance liabilities
• Working knowledge of Electronic Health Records (EHR) and audit management systems, high technical aptitude with ability to learn quickly and audit systems appropriately
• Strong conflict-resolution skills with capability to provide creative solutions to problems that arise both internally and externally (vendors)

Education, credentials, and/or trainings required

• High school diploma or GED from an accredited institution required
• Associate, Bachelor’s, or Master’s degree or active Pharmacy Tech license preferred
• Minimum of one to two (1-2) years of experience in healthcare compliance, auditing, or operations preferred
• Prior experience in a 340B compliance role preferred
• Certification in Healthcare Compliance (CHC) or 340B Advanced Certificate (340B ACE) preferred

Physical demands