Position Summary
The Clinical Compliance and Operations Auditor is responsible for conducting rigorous onsite evaluations to ensure centers maintain the highest standards of operational and clinical integrity. This role involves performing "surprise" audits to observe real-time operations, conducting facility walk-throughs, and auditing client records. The Auditor serves as a critical frontline evaluator, preparing local staff for external reviews from payors and accreditation bodies while providing data-driven feedback to leadership.
Duties and Responsibilities
Onsite Audit and Evaluation
- Conduct unannounced onsite reviews of centers within an assigned territory to observe live operations.
- Implement comprehensive center walk-throughs to ensure compliance with physical site and safety standards.
- Interview clinical and operational staff to assess knowledge and adherence to company and regulatory protocols.
- Review client records and clinical documentation to ensure compliance with payor and regulatory practices.
- Prepare center staff to respond effectively to external evaluators, including payors and accreditation bodies (e.g., JCAHO, BHCOE).
Reporting and Data Analysis
- Compile and generate detailed audit reports following each visit, summarizing findings for internal stakeholders.
- Log audit details and progress in a trackable, real-time format.
- Provide data-in-practice to inform leadership on time overhead for travel, report writing, and debriefing.
- Monitor adherence to clinical quality elements of payor Corrective Action Plans.
- Generate detailed, quantitative audit reports, ensuring finding classifications and raw data support executive-level trend analysis and risk forecasting.
Professional Responsibility and Internal Reporting
- Follow internal standards and requirements for reporting concerns to the appropriate leaders and facilities.
- Follow up on reporting to ensure investigation, decision making, and resolution or key concerns.
- Compliance with Centria’s Code of Conduct, policies and procedures, and Federal and State laws.
- Responsibility to report violations of Company policies or the Code of Conduct.
Rate
$95,000 - $110,000 per year plus bonus
Qualifications
Education
- Master’s degree required
- Doctorate preferred
- BCBA certification
- BCBA-D preferred
Work Experience
- Minimum of 10 years of experience as a BCBA or higher.
- Minimum of 3 years of experience in a senior leadership role overseeing clinical compliance for a large-scale, multi-state healthcare organization.
- Proven track record navigating Medicaid, OIG, and private payor clinical audits.
- Deep mastery of the BACB Ethics Code for Behavior Analysts and HIPAA privacy regulations.
- Proven record of success in a highly detail-oriented, evaluative environment, experience in compliance or operational auditing preferred
- Knowledge of ABA clinical and documentation best practices and terminology.
- Experience with clinical review or payor clinical review responses.
Equipment and Technology Requirements
- Working knowledge of laptop/desktop PC
- Proficiency in Microsoft Suite (Word, Excel)
- Proficiency in G Suite (Gmail, Drive, Docs, Sheets, Google Meet)
Other Competency Requirements
- Ability to follow written instructions
- Ability to use computers and computer/software programs
- Ability to communicate expressively and receptively
Knowledge and Skills
- Proven ability to design, implement, and manage robust operational processes that support organizational growth while maintaining high performance.
- Strategic mindset focused on identifying efficiencies and driving continuous improvement across a national, high-volume provider network.
- Advanced skill in detecting systemic operational and compliance risks within complex delivery models and implementing proactive safeguards.
- Ability to bridge the gap between rigorous regulatory documentation requirements and a child-led, compassionate care model.
- Proficiency in leveraging compliance frameworks not just as a "check-the-box" exercise, but as a tool to solve complex business problems.
- Expert knowledge of ACQ coordination processes and the ability to lead initiatives that sustain industry-leading quality standards.
- Demonstrated success in leading and mobilizing Subject Matter Experts (SMEs) to address and resolve multifaceted organizational challenges.
- Ability to align diverse stakeholders around shared quality benchmarks and operational goals.
- Capacity to view local issues through a national lens, ensuring consistency in care and compliance across all regions.
- Ability to travel up to 80% of the time within the assigned territory.
- Excellent written and verbal communication skills for debriefing staff and writing reports.
Working Conditions
- Centria's office hours are Monday through Friday from 8:30 AM – 6:00 PM.
- Additional time or occasional shift in schedule may be required to complete the above work or meet company objectives.
- Weekly travel (Monday thru Thursday) to regional centers and the Resource Center for site audits and leadership summits will be required.
Physical Demands
While performing the duties of this job, physical requirements such as bending, reaching, lifting, pushing, or pulling up to 30 pounds may be required. This role will require sitting most of the day as well as walking and standing periodically. This role may require close visual acuity on computer screens or monitors and the ability to analyze data and figures on a screen.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, Veteran status, or disability status. This job description is not intended to be an exhaustive list of qualifications, skills, efforts, duties, responsibilities, or working conditions associated with the position. Centria reserves the right to amend this job description at any time, with or without written notice.