Healthcare Internal Auditor

Job Title: Healthcare Internal Auditor

Reports to: Director - Internal Audit & Compliance Operations

Position Summary:

The Healthcare Internal Auditor independently plans and executes risk-based audits to ensure adherence to regulatory requirements, internal policies, and best practices. Under the direction of the Internal Audit department, the Healthcare Internal Auditor is responsible for assessing regulatory compliance, identifying and mitigating risks. This role identifies control gaps, operational strengths and/or inefficiencies, areas for improvement, and provides recommendations. The auditor partners with clinical, administrative and key stakeholders to strengthen the health system performance and mitigate risk.

The position also collaborates closely with the Compliance department and other organizational stakeholders to identify strengths and gaps and to develop actionable recommendations that optimize systems, mitigate risks, reinforce internal controls, and ensure adherence to Luminis Health policies, procedures, and regulatory requirements.

Essential Job Responsibilities:

·         Coordinate and lead in the assessment of risks associated with LH, including the development of the system-wide annual audit work plan.

·         Work with hospital compliance and operational teams to identify risks through targeted risk assessments and audit activities.

·         Develop audit scopes, objectives and testing procedures aligned with risk-based planning, regulations, and policy.

·         Conduct audit activities to ensure the integrity and compliance of hospital operational processes by reviewing and analyzing data, records, policies & procedures and are aligned according to federal and state program guidelines.

·         Analyze audit findings, draft audit summary findings in written reports, provide detailed comments related to the audit findings, identify potential risks, and collaborate with relevant departments to make recommendations with tracking and follow-up on completion of corrective actions.

·         Understands general healthcare business process and can apply risk and control concepts as appropriate.

·         Supports special project initiatives, under the strategic direction of the Director of Internal Audit and Compliance Operations.

·         Maintain department audit standards, protocols, policies, and guidelines to ensure alignment with evolving regulatory frameworks.

·         Maintain up-to-date knowledge of healthcare regulations, guidelines, and best practices in auditing.

 Minimum Qualifications:

·         Bachelor’s degree in healthcare administration, Healthcare Auditing, Accounting, Compliance, or a related field.

·         Three to five years auditing in the healthcare industry with experience leading audit projects.

·         Experience with internal audit methodology and application of concepts in audit delivery and execution.

·         Detail-oriented with strong critical thinking, organizational, and time management skills required to multitask effectively and adapt to changing priorities and responsibilities.

·         Strong verbal and written communication skills i.e. report writing, closing summaries, and presentations.

·         Strong knowledge of Federal regulations and guidelines as well as interactions as they relate to billing and coding compliance, including Medicare Conditions of Payment/Participation.

·         Professional Certification (CHIAP, CIA, CPA, CISA, or CFE) preferred.

Preferred Skills:

·         Must be proficient in Microsoft Office applications (Word, Excel, PowerPoint, and Outlook) and Electronic Medical Record platforms (Epic).

·         Familiarity with healthcare information systems and data analytics tools.

·         Ability to work independently, efficiently, and manage competing priorities.

Experience and knowledge of Maryland All-Payer and AHEAD Models preferred