Director of Internal Audits

Our client is seeking to add a Director of Internal Audits to their team.

Strategic oversight of the internal audit function across the organization ensuring risk-based audit coverage and providing independent and objective assessment of the organization’s governance, risk management, and internal control systems. Responsible for planning, executing, and reporting on operational and regulatory compliance-related audits and reviews. Ownership of the Internal Audit Workplan.

• Oversees and ensures audit work is performed and documented in accordance with departmental standards.
• Owns the responsibility of Internal Audit Work Plan-this plan will include all specificities such as audit description, frequency, and audit sampling.
• Plan audits that Office of Inspector General and the Office of the Medicaid Inspector General will be reviewing as part of their workplan and ensure the Company is compliant.
• Assigns and ensures implementation of the work plan and benchmarks progress.
• Acts as primary liaison between the department’s employees, appropriate Vice Presidents and division heads.
• Works with the Compliance Officers to collaborate and own audits that are on the Compliance Work Plans.
• Ensures audits are being conducted on medical record documentation to identify under coded and up coded services; reviews report findings and sends to the physicians to provide awareness/education on accurate coding practices and compliance issues.
• Prepares timely audit reports for Executive Management, Compliance Officers and the Chief Financial Officer.
• Meet deadlines of assignments, multitask multiple demands and work with all types of individuals up to and including the Chief Financial Officer.
• Research, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Interacts with physicians, business offices, provider enrollment, managed care, informatics and other departments regarding timely and accurate billing, and documentation, policies and procedures and regulations; obtains clarification of non-specific documentation.
• Acts as a team player, collaborating and supporting colleagues and peers across the organization, while still capable of working independently when needed.
• Attends conferences, workshops and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Designs audit plans and annual work plans.
• Assesses with other departments regarding risk assessments and corrective actions.
• Cultivate relationships across departments to promote ethical practices, transparency, and continuous improvement.
• Lead, mentor, and develop internal audit staff; foster a culture of accountability, learning, and professional development.
• Promote a continuous improvement mindset and help build audit capacity across the organization.
• Performs other incidental and related duties as required and assigned.

• High school diploma or GED required.
• Bachelor’s degree in Business Administration, Health Care Administration or related appropriate field required.
• 5 to 7 years’ minimum experience in auditing, preferably within a healthcare organization.
• 10 years' experience minimum in a supervisor position.

• Related experience preferred.
• Ability to direct, manage and supervise employees.
• Knowledge of CPT codes and ICD-9/10 codes.
• Knowledge of CMS Guidelines.
• Knowledge of Federal and State Compliance regulations.
• Knowledge of anatomy and medical terminology.
• Ability to conduct interviews and gather information.
• Knowledge of analytical ability.
• Ability to maintain confidentiality while multitasking.
• Excellent organizational skills and the ability to balance multiple tasks and priorities while focusing on the details.
• Strong interpersonal, verbal and written skills required.
• Ability to function well in a high-paced and at times stressful environment.
• Excellent time management skills with a proven ability to meet deadlines.
• Demonstrates strong communication, written, and typing skills.
• Proficient with Microsoft Office or related software.
• Ability to work efficiently both independently and in a team environment.
• Strong project management and team leadership capabilities
• Exceptional organizational skills and detail-oriented.

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• The work requires the following activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed primarily indoors.
• The employee must occasionally lift and/or move up to 25 pounds.

Skills:

cpt codes,icd-9/10 codes,audit,healthcare,cms guidelines