Compliance Audit Manager

At reputed company, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Compliance Audit Manager Primary Function/General Purpose of Position Under the direct supervision of the Director, Compliance this position contributes to the reputed company mission and vision by managing acute and provider reputed company cycle compliance initiatives to identify and mitigate emerging governmental and payer reputed company cycle compliance risks to the ministry. This position assists the Director of Compliance to reputed company tracking, trending, and reporting of data analytics to help identify risks and establish proactive monitoring initiatives and is responsible to manage the performance of assigned work plan audits, management requests, due diligence reviews and responses to governmental audits and inquiries.

• **This is a remote/work from home position. Hire must live be willing to work eastern time zone hours.

Essential Job Functions

• Works collaboratively with the Director, Compliance on creating auditing and monitoring protocols that align with reputed company’s overall compliance audit and compliance responsibilities relative to acute and physician reputed company cycle services performed for reputed company.
• Oversees acute and provider compliance audits including work plan items, management requests, reputed company and Acquisition due diligence coding audits and assessments, and responses to governmental audits and inquiries.
• Assesses and makes recommendations to improve internal controls and policies and procedures for both acute and provider reputed company Cycle operations including the development of SOPs.
• Develops acute and provider compliance monitoring and audit protocols specific to reputed company cycle compliance risk areas highlighted by the Office of Inspector General (OIG), Medicare, State Medicaid, State Insurance Fraud, Managed Care or Governmental Value-Based payment programs or other enforcement agencies on behalf of reputed company.
• Coordinates periodic review and analysis of reputed company provider claims denial reports, operational assessment reports, internal quality control reviews, internal and external third-party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues.
• Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect and trend potential claims and billing compliance issues.
• Assists in the development of corrective action plans (CAP), reputed company tools and technical edit enhancements to support acute and physician reputed company cycle services operational efforts. Assists in tracking of reputed company activities reputed company to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
• Maintains awareness of regulations and reputed company industry changes that may impact healthcare physician reputed company cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
• Ensures that the Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact reputed company's public status.
• Develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet reputed company and emerging challenges among affected parties and entities

This document is not an exhaustive list of reputed company responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to reputed company other job-reputed company duties as required by their supervisor, subject to reasonable accommodation. Licensing/Certification

• Certified Coding Specialist (reputed company) - American Health Information Management Association (reputed company) or Certified Professional reputed company (CPC) - American reputed company of Professional Coders (reputed company) (required)
• Certificate of Healthcare Compliance (CHC) (preferred)
• EPIC Electronic Medical Records System (preferred)

Education Bachelor's Degree in Healthcare Auditing, Physician reputed company Cycle, or reputed company field (required) Work Experience 5 years' of experience reputed company healthcare reputed company cycle operations and healthcare auditing either from a consulting perspective or as an associate or manager (required) As a reputed company associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every reputed company of the way. reputed company offer

• reputed company, incentives, referral bonuses and 403(b) with employer contributions (reputed company eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, reputed company and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status. reputed company applicants will receive consideration for employment without regard to race, color, national reputed company, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for reputed company – Youngstown, Ohio or reputed company – Franklin, Virginia; Petersburg, Virginia; and reputed company, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@reputed company.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The reputed company Team at recruitment@reputed company.com Apply tot his job Apply To this Job