Healthcare Compliance Audit Manager
4 weeks ago
The Coding Audit Education and Quality Assurance Manager is responsible for managing a team of DRG Validation Specialists/Educators, Outpatient Quality Compliance auditors, Clinical Coding Compliance auditors, and Behavioral Health Clinical Coding audit educators. This role oversees and validates the statistical reports and analysis of audit findings and delivers them to Coding Leadership, Central Business Office Leaders, and the Maine Health Audit Committee with subsequent process improvement recommendations. The manager assists with responses and education to the ongoing corporate risk audit process and the development of the educational follow-up work plan, as required.
Key Responsibilities
- Manage a team of auditors and educators to ensure compliance with healthcare regulations and guidelines.
- Oversee the development and implementation of audit plans and procedures.
- Validate statistical reports and analysis of audit findings.
- Deliver reports and recommendations to leadership and the audit committee.
- Assist with responses and education to the ongoing corporate risk audit process.
Education: A Bachelors' degree in Healthcare Administration, HIM or a related business field is required.
License/Certification: Possess one or more of the following certifications: CPC, COC, CPMA, CHC, CPCO, CCS-P, CCS, RHIA, RHIT or CIC.
Experience: Five or more years' progressive healthcare compliance audit and/or coding experience. Prior management experience preferred.
Skills and Abilities:
- Leadership and analytical ability to guide the auditing team.
- Ability to analyze and interpret clinical and administrative healthcare data.
- Knowledge of physician and hospital billing practices, CMS regulations, CPT coding guidelines, DRG methodology, and commercial payer guidelines.
- Ability to establish and maintain effective working relationships with physicians, attorneys, administrators, and hospital personnel.
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