Compliance Audit Manager
Bon Secours Mercy Health
full-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Works collaboratively with the Director, Compliance on creating auditing and monitoring protocols that align with Bon Secours Mercy Health’s overall compliance audit and compliance responsibilities relative to acute and physician revenue cycle services performed for Bon Secours Mercy Health.
- Oversees acute and provider compliance audits including work plan items, management requests, Merger 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 Revenue Cycle operations including the development of SOPs.
- Develops acute and provider compliance monitoring and audit protocols specific to revenue cycle compliance risk areas.
- Coordinates periodic review and analysis of Bon Secours Mercy Health 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.
- 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), oversight tools and technical edit enhancements to support acute and physician revenue cycle services operational efforts.
- Assists in tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
- Maintains awareness of regulations and current industry changes that may impact healthcare physician revenue 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 Bon Secours Mercy Health'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 current and emerging challenges among affected parties and entities
Requirements
- Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) (required)
- Certificate of Healthcare Compliance (CHC) (preferred)
- EPIC Electronic Medical Records System (preferred)
- Bachelor's Degree in Healthcare Auditing, Physician Revenue Cycle, or related field (required)
- 5 years' of experience within healthcare revenue cycle operations and healthcare auditing either from a consulting perspective or as an associate or manager (required)
Benefits
- Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
- Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
- Paid time off, parental and FMLA leave, shot- and long-term disability, backup care for children and elders
- Tuition assistance, professional development and continuing education support
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
auditing protocolsmonitoring protocolsinternal controlsdata analyticsstatistical analysismodelingcorrective action plansclaims auditbilling complianceSOP development
Soft Skills
collaborationcommunicationdecision-makingnetworkingproactive responseeducational content developmentanalysisrecommendationpresentation skillsawareness of regulations
Certifications
Certified Coding Specialist (CCS)Certified Professional Coder (CPC)Certificate of Healthcare Compliance (CHC)