Manager, Billing Compliance Audit Services Job in Cleveland, Ohio

Job Summary:

Under the direction of the Director of Audit Services, oversees auditing and monitoring activities to ensure compliance with applicable hospital and professional billing, and coding rules and regulations.  Collaborates with leadership to ensure execution of an effective compliance program. Upholds the mission, vision, values, and customer service standards of The MetroHealth System. 

Responsibilities:

1. Contributes to patient safety, by supporting the system-wide programs and policies, addressing a safe environment for patients and the reporting of safety concerns to the appropriate individuals.

2. Under the direction of the Director of Audit Services, supervises the day-to-day activities of the Ethics and Compliance Billing Compliance Monitors.

3. Develops and implements effective auditing and monitoring activities of the healthcare services billed system-wide.

4. Designs audit tools, methodologies and reporting mechanisms to ensure efficient audit practices.

5. Develops and monitors quality assurance and productivity standards of the work assigned to the Billing Compliance Monitors.

6. Participates in the development of the Ethics and Compliance work plan.

7. Coordinates staffing needs to meet completion of the relevant Ethics and Compliance work plan items.

8. Develops, maintains and effectively communicates relevant billing and coding policies and procedures.

9. Monitors regulatory communications of the Medicare Administrate Contractor, Ohio Department of Medicaid, Office of Inspector General and/or other governmental agencies or private payers through alerts, bulletins, advisory opinions, or any other means to assess real or potential risk to the organization.

10. Assesses the work plan of the Office of Inspector General (OIG), Medicare Recovery Audit Contractors, Medicaid Integrity Contractors or the Comprehensive Error Rate Testing (CERT) database and develops and assigns auditing and monitoring projects accordingly.

11. Develops and coordinates effective educational and training programs for all staff on documentation guidelines and accurate coding requirements. 

12. Functions as a resource for staff, clinicians and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.

13. Reviews confidential reports summarizing the findings of audits and/or special chart reviews and ensures information is communicated accurately.

14. Oversees follow-up audits as necessary to ensure the error rates are decreasing and/or escalates ongoing or egregious audit findings to the Detected Deficiency Work Group.

15. Communicates and collaborates on billing and coding issues through the SporC and/or Epical Work Group.

16. Leads the Physician Billing and Coding Compliance Committee.

17. Assists in confidential and highly sensitive investigations and/or verification of reported compliance concerns.

18. Develops and monitors metrics to assess the effectiveness of the auditing and monitoring activities.

19. Continuously seeks opportunities to improve the auditing and monitoring activities and ensures activities are aligned with the goals and objectives of the Ethics and Compliance Department as well as the organization while maintaining audit accuracy.

20. Performs other functionally related duties as assigned.

Qualifications:

Required:        

Bachelor’s degree in Business, Health Administration, or related fCHCield or minimum five years of equivalent work experience in lieu of degree.

Five years of experience in coding (CPT-4/ICD-10)

Working knowledge of healthcare reimbursement and revenue cycle management.

One to two years of supervisory/management or demonstrated leadership experience.

Proficient with Microsoft Office products.

Strong quantitative skills.

Excellent verbal and written communication skills.

Possesses certification from the American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA).

Preferred:

Certification in Healthcare Compliance (CHC) through Health Care Compliance Association (HCCA).

Epic billing systems

Physical Demands:

May need to move around intermittently during the day, including sitting, standing, stooping, bending, and ambulating. 

May need to remain still for extended periods, including sitting and standing.

Ability to communicate in face-to-face, phone, email, and other communications.

Ability to read job related documents.

Ability to use computer.