Compliance Audit Manager

Compliance Audit ManagerEthics & 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.Reporting to the Compliance Director, this position supervises and manages compliance audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services. 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.Responsibilities include:Planning 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.Preparing written reports of audit findings and recommendations; presenting to appropriate stakeholders; evaluating the adequacy of management corrective action to improve deficiencies; maintaining audit records.Conducting 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 as well as healthcare industry best-practices.Developing and implementing compliance training and education 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.Providing feedback and training for physicians and staff regarding coding insufficiencies.Serving 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.Serving as liaison with 3rd party auditors conducting audits as well as managing in-house auditing staff.Supporting the overall workplan of the Compliance Department.Qualifications include:Bachelor's degree in Health Information Management, Business or related field preferred.6+ years of experience in physician and/or hospital coding and auditing, medical necessity reviews, or related work; cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge a plus.AAPC, AHIMA or HCCA Coding certification and or Auditing/Compliance certification (CPC, CCS, CCS-P, COC, CPMA, CHC) preferred.Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.Understands institutional risks and shows appropriate judgment, using a risk-based approach in planning and executing audit plans.Expert-level knowledge and application of Medicare/Medicaid documentation and coding rules and guidelines; ICD/CPT/HCPCS/DRG/APC documentation coding rules; medical terminology; E/M rules; healthcare compliance audit methodology, principles and techniques; ability to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation during audit reviews.Ability to communicate complex and potentially sensitive issues to all levels of management, physicians, and others; strong presentation and communication skills (MS Word, Excel, PowerPoint, and Outlook).What is expected of you and others at this level includes:Managing department operations and supervising professional employees, front line supervisors and/or business support staff.Applying advanced knowledge and understanding of concepts, principles, and technical capabilities to manage a wide variety of projects.Participating in the development of policies and procedures to achieve specific goals.Recommending new practices, processes, metrics, or models for a successful auditing program.Possessing strong attention to detail.Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment.Independently determining method for completion of new projects.Receiving guidance on overall project objectives.Excellent time management, personal integrity and ability to maintain confidentiality.Anticipated salary range: $105,100 - $140,100. Bonus eligible: Yes.Cardinal Health offers a wide variety of benefits and programs to support health and well-being including:Medical, dental and vision coveragePaid time off planHealth savings account (HSA)401k savings planAccess to wages before pay day with myFlexPayFlexible spending accounts (FSAs)Short- and long-term disability coverageWork-Life resourcesPaid parental leaveHealthy lifestyle programsApplication window anticipated to close: 01/07/2025. If interested in the opportunity, please submit your application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day.Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.