Compliance Audit Manager
RemotePosted 2 months ago Expired
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Upload Your ResumeAbout This Role
Manage acute and provider revenue cycle compliance initiatives within Bon Secours Mercy Health to identify and mitigate emerging governmental and payer compliance risks. This role assists the Director of Compliance with data analytics, monitoring, auditing, and responding to governmental inquiries.
Responsibilities
- Collaborate with the Director, Compliance on creating auditing and monitoring protocols for acute and physician revenue cycle services
- Oversee acute and provider compliance audits including work plan items, management requests, and M&A due diligence coding audits
- Assess and recommend improvements to internal controls, policies, and procedures for Revenue Cycle operations
- Develop acute and provider compliance monitoring and audit protocols specific to revenue cycle risk areas highlighted by regulatory bodies
- Coordinate periodic review and analysis of provider claims denial reports and operational assessments to detect billing trends
- Utilize data analytics techniques, statistical analysis, and databases to detect and trend potential claims and billing compliance issues
- Assist in the development of corrective action plans (CAP), oversight tools, and technical edit enhancements for revenue cycle services
- Maintain awareness of regulations and current industry changes impacting healthcare physician revenue cycle services
- Apprise the Director, Compliance of emerging issues, adverse outcomes, and deficiencies impacting Bon Secours Mercy Health's public status
- Develop educational content and trend non-compliant activities to enhance proficiency and competency
Requirements
- 5+ years of experience within healthcare revenue cycle operations and healthcare auditing
- Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)
- Bachelor's Degree in Healthcare Auditing, Physician Revenue Cycle, or related field
Qualifications
- Bachelor's Degree in Healthcare Auditing, Physician Revenue Cycle, or related field
- 5 years' of experience within healthcare revenue cycle operations and healthcare auditing
Nice to Have
- Certificate of Healthcare Compliance (CHC)
- EPIC Electronic Medical Records System experience
Skills
* Required skills
Benefits
Certifications
About Mercy Health
Mercy Health is a faith-based and patient-focused organization that enhances the health and well-being of all people in mind, body and spirit through exceptional patient care.