Job Description

SKILLS REQUIRED

• Strong understanding of relevant laws, regulations, and industry standards.
• Experience in developing and implementing compliance programs.
• Excellent investigative and problem-solving skills.
• Ability to develop and implement corrective action plans.
• Strong communication and training skills.
• Experience in monitoring and enforcing compliance through audits and investigations.
• Ability to develop and maintain clinical quality systems.
• Strong organizational and coordination skills.

THE ROLE

The Clinical Auditor is responsible for ensuring that the organization maintains high standards of compliance and quality within its clinical operations. This role involves conducting various types of audits, providing advice and communication, performing administrative duties, engaging in self-audit activities, participating in training, and attending relevant meetings.

KEY RESPONSIBILITIES

• Conducting various types of audits, including regular, CHA, and AEA audits.
• Auditing files, clinicians, and conducting remediation checks.
• Performing targeted Claims checks on a monthly basis.
• Engaging in audit activities and preparing for each audit.
• Preparing for and conducting self-audit activities.
• Engaging in clinical and professional development and training the trainer sessions.
• Attending meetings with field and management staff, external stakeholders, and participating in clinical compliance huddles.
• Consulting with the compliance team and attending Amplifon-specific meetings.
• Responding to phone calls and emails from the field,management and back office.
• Liaising and engaging with HSP, including responding to challenges and conducting HSP audits.
• Updating procedures and policies and preparing resources for the field.
• Setting up the audit plan for the year and supporting professional registration for HR.
• Developing and implementing compliance programs addressing key areas such as billing, coding, patient privacy, and fraud prevention.
• Investigating compliance issues, identifying root causes, and recommending corrective actions.
• Developing and implementing disciplinary action plans to address recurring compliance issues.
• Monitoring and enforcing compliance with all applicable laws, regulations, and internal policies through audits, investigations, and corrective actions.
• Developing and maintaining clinical quality systems consistently across the organization.
• Overseeing national clinical policies and procedures within the document control process.
• Creating and implementing strategies for managing clinical risks and enhancing care quality.
• Supporting and mentoring staff on quality improvement tools and methods, and providing training to ensure all employees understand their compliance obligations.
• Monitoring HR processes and validating compliance with accreditation requirements.
• Reporting on quality system performance, ensuring alignment with standards and stakeholder needs.
• Coordinating compliance efforts with other departments to ensure integration of compliance requirements into all aspects of the business.