Job Description
Role and Responsibilities
• Determining internal audit scope and developing audit plans
• Performing the full audit cycle including risk management and control management over operations effectiveness and compliance with all applicable directives and regulations
• Create awareness among the employees about quality management and information security management system
• Adding value and improving the operations by bringing a systematic and disciplined approach to the effectiveness of risk management, control, and governance processes
• Able to develop policies and procedures based on the process
• Coordinate with internal and external stakeholders for the smooth functioning of audits
• Coordinate with external auditors and vendor audits
• Prepare and present audit reports that reflect audit results
• Publishing dashboard on the results of audits conducted with SWOT analysis
• Coordinate for Management Review Meeting
• Follow up with various teams for the proper closure of non-conformity
• Driving the audit towards customer satisfaction, statutory and regulatory requirements

Influence & Communication
• Coordinates regularly with various stakeholders to meet the standard requirements
• This position may require desirable knowledge of applicable data privacy practices and laws
• This role may have access to sensitive data to include PII and ePHI
• Candidates should be preferably from data processing organizations / ITES
• Good communication skills

Education
• Any UG degree or PG degree

Experience
• 10 plus years of experience in processes and auditing preferably in Governance, Risk and Compliance function

Certification
• ISO 9001:2015 and 27001:2022 Lead Auditor certificate from IRCA approved certification agency

Skills and knowledge
• Should have conducted at least 15 internal and faced 5 external audits based on ISO 9001 and 27001 standards
• Knowledge on data protection standards
• Good communication skills and working knowledge on MS Excel

Job Description
Role and Responsibilities
• Candidates should be proficient with QuickBooks (Desktop Version). Assist in the day-to-day operations and will maintain financial records and reports, perform accounting reconciliations, maintain accounts payable documentation, and will assist in other tasks requested by management.
• Must have strong knowledge in GAAP, Journal entries, provision entries, other AP/AR related processes with proper documentation.
• Ensure compliance with accounting deadlines, monthly bank and balance sheet reconciliations.
• Prepare monthly financials statements and variance analysis.
• Must communicate effectively verbally and written.
• Good accounting knowledge – concepts of accounting and accounting principles.
• Good compliance knowledge – concepts of TDS provisions, GST provisions and SEZ compliance.
• Ensure the integrity of accounting information by recording, verifying, and entering transactions.
• Ability to complete multiple duties with accuracy shifting from one to another and completing deadline.
• Perform administrative duties such as maintaining schedules, filing and scanning documents.
• Good knowledge in MS office especially Excel formulas and shot cut keys.
• Effective interpersonal skills and ability to work independently in a team environment.
• Excellent attention to details and strong analytical abilities

Qualifications and Education Requirements
• Any Graduate
• Minimum 3- 5 years of experience in Accounting and Finance Standards

Preferred Skills
• Good accounting knowledge - basic concepts of accounting and basic accounting principles.
• Good compliance knowledge - basic concepts of TDS provisions, GST provisions and SEZ compliance.
• Ensure the integrity of accounting information by recording, verifying, and entering transactions.
• Ability to complete multiple duties with accuracy shifting from one to another and completing deadline.
• Good knowledge in MS Office specially Excel formulas and shot cut keys.
• Effective interpersonal skills and ability to work independently in a team environment.
• Excellent attention to detail and strong analytical abilities and good communication

Required Certifications
• Completed CA/CMA Inter within the last 3 years

Job Description
JOB RESPONSIBILITIES:
The Compliance Auditor is responsible for planning and conducting audits for clinical and administrative processes, including coding and billing compliance, documentation, medical necessity, adherence to internal policies, procedures and guidelines, services provided by outside vendors including revenue cycle vendor, and compliance with state and federal regulations including HIPAA Privacy and Security. The Compliance Auditor is responsible for preparing and submitting written audit reports that include findings and recommendations, communicating findings to the Director, developing and implementing corrective action plans when necessary, and following up to ensure that corrective plans are implemented and were effective.

Implement the Audit Process
• Plan and schedule audits, including identifying the audit subject and purpose, defining audit objective(s), defining audit scope, performing pre-audit planning, and notification to the area(s) to be audited.
• Conduct audits, including meeting with impacted employees and keeping impacted organizational areas(s) apprised along the way of any findings and urgent actions to be taken if necessary.
• Develop audit reports that includes findings, recommendations designed to correct any potential weaknesses or areas of noncompliance discovered during the audit, request for management response to each finding or recommendation including corrective action plan(s) to be developed and implemented.
• Provide follow-up prior to closing the audit including confirming successful implementation of corrective action plans, verify that management responses are implemented, and assess new processes, procedures and actions.

Stay Abreast of Applicable Regulatory Changes
• Maintain current knowledge of medical documentation, fraud, abuse, and documentation and coding violations based on governmental guidelines, including State and Federal overpayment regulations.
• Stay abreast of and maintain current knowledge of Medicare and Medicaid guidelines applicable to Pain Management Clinics and Ambulatory Surgical Centers (ASCs), including applicable Local Coverage Determinations (LCDs).
• Maintain current knowledge of requirements and guidance required in the performance of audit duties, including but not limited to ICD-10, HCPCS, and CPT coding, modifiers, and surgical procedures documentation requirements.
• Maintain current knowledge of HIPAA Privacy and Security Requirements.

Conduct Audits
• Review medical records to determine the medical necessity of services billed and the accuracy of coding, billing, and supporting clinical documentation in either an Ambulatory Surgical Center (ASC) or a Pain Management Clinic.
• Review records that have been reviewed and coded by the revenue cycle vendor.
• Review client practices, procedures, and materials for compliance with CMS and HIPAA regulations.
• Prepare audit reports of findings and observations that identify, in detail, areas of non- compliance and risk areas for non-compliance.
• Ensure corrective actions are implemented and effective.
• Conduct other audits as assigned, including but not limited to contract reviews, lease agreements, compliance with contract language, etc.
• Share departmental responsibilities as assigned.

JOB REQUIREMENTS:
• Bachelor’s degree in accounting, business administration, or healthcare related field required.
• AAPC Certified Professional Coder (CPC®) or AHIMA Certified Coding SpecialistPhysician-based (CCS-P) certification, required.
• Certified Professional Medical Auditor (CPMA) certification preferred.
• Healthcare compliance certification, a plus.
• A strong understanding of healthcare regulations, such as HIPAA, Medicare, Medicaid, and other relevant industry standards, is essential.
• Solid grasp of auditing principles, techniques, and methodologies.
• Experience working autonomously.
• Healthcare auditing, billing/coding experience, required.
• A minimum of 5 years’ experience in healthcare compliance.

KNOWLEDGE, SKILLS, AND ABILITIES:
• Knowledge of federal (including HIPAA) and state regulatory requirements.
• Strong analytical and critical thinking skills.
• Attention to detail and the ability to think strategically.
• Excellent written and verbal communication skills to present findings and results effectively.
• Ability to work well in a team, contribute effectively, and manage priorities.
• Good computer software skills and knowledge.
• Knowledge of data analysis and audit software tools is a plus.

HOURS AND WORKING CONDITIONS:
Our corporate office is located in Tampa, FL. This job may require travel to PPOA locations throughout Florida, Texas, and California.

Job Description
Role and Responsibilities
• Impart training for New Hires joining RCM
• Develop assessments and assignments to accurately assess the trainee’s learning
• Develop and deliver classroom-based training with a good number of hands-on sessions and activities
• Adopt training methodologies to ensure the users have a steep learning curve
• Coaching: One-on-One coaching for individual areas of improvement
• Monitor and report the progress of the New Hires till they are complete their scheduled training program
• Coach/mentor the New Hires on call handling skills
• Conduct refresher trainings
• Periodic evaluations and assessments for the New Hires and on floor analyst on the training imparted and on floor client updates
• Maintain the progress data of each trainee and be able to analyze Training Need of each user to help them up the learning curve in a short span
• Be innovative and flexible in adopting an approach to maximize the learning of the users
• Mentor/Coach the agents during the initial period of “Go-Live” to achieve the required target on operations

Process-Specific Training: Whenever we hire someone, irrespective of a fresher or an experienced candidate, we must create a mandatory situation of undergoing Process specific training. This will help both process leaders and associates in expediting the learning process at the time of ramp-up period.

Software Training: We can conduct the software training along with the process training for new hires. On a need basis, we can conduct it for associates whom we move internally from one process to another. Eventually, this also will help both process leaders and associates expedite the learning process at the time of the ramp-up period.
Provide special attention to the associates who are in PIP / QIP. Perform weekly regular audits and share feedback regularly until they meet the expectations

Qualifications and Education Requirements
• Any Graduation
• Minimum 5 years of experience in RCM background is Mandatory

Preferred Skills
• Excellent Presentation Skills
• Good knowledge of Microsoft Office
• Knowledge in physician billing, hospital billing, ASC Billing
• Prior experience in a Quality team will be advantageous
• A basic understanding of content research and development is preferred

Communication Skills (Excellent/Good/Medium)
• Excellent Writing, Speaking and Reading skills are preferred

Required Certifications
• Any Medical billing / Training certification will be an added value

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