Compliance Audit Manager

What Ethics & Compliance contributes to Cardinal Health

Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Ethics & Compliance develops and implements strategies and standard operating procedures to promote adherence to internal ethics and compliance policies related to areas such as privacy, HIPAA and FCPA, among others. This job family resolves concerns from business unit leaders and employees and proactively provides guidance and trainings on policies.

Reporting to the Director, Ethics & Compliance, this position supervises and manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation of the adequacy and accuracy of documentation in support of services billed;

compliance with other documentation and coding and billing standards; communication of audit results to physicians, physician leadership, senior leadership, management, and staff; physician and coder education; and the making of recommendations for corrective action to leadership, coders, billers and other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan.

The Manager has supervisory responsibility for all Compliance Audit staff.

What is expected of you and others at this level

• Manages department operations and supervises professional employees, front line supervisors and/or business support staff

• Participates in the development of policies and procedures to achieve specific goals

• Ensures employees operate within guidelines

• Decisions have a short term impact on work processes, outcomes and customers

• Ability to work in a team environment and perform multi-job functions.

• Knowledge of medical terminology and electronic medical records.

• Professional and/or hospital services auditing experience.

• Exceptional Customer Service Skills.

• Proven interpersonal communication skills.

• Excellent time management, personal integrity and ability to maintain confidentiality.

Responsibilities

• Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management

• Interactions normally involve resolution of issues related to operations and/or projects

• Gains consensus from various parties involved

• Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.

• Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and/or medical necessity reviews.

• Manages focused audits involving specific errors/issues that are identified by the RCM team or by clinic teams. Leads data analytics and the revenue cycle team in identifying the time period of review and conducts a focused audit to identify any financial liability of the Company.

• Evaluates the appropriateness of billed services and procedures based on supporting record documentation and ensures documentation by providers conforms to legal and procedural requirements.

• Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.

• Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories and healthcare industry best-practices.

• Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.

• Conducts compliance orientation training for new providers as well as Revenue Cycle team members, as needed.

• Provides feedback and training for physicians and staff regarding coding insufficiencies.

• Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.

• Facilitates assigning of ICD-9 and ICD-10 codes by analyzing patient medical records.

• Availability to assist with research of denied claims.

• Maintains a functional knowledge of enterprise EMRs, the registration process and charge entry.

• Supports the overall…