Healthcare Compliance Audit Manager

4 weeks ago


Scarborough, Maine, United States Maine Medical Center Full time
Job Summary

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.
Requirements

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.


  • Scarborough, Maine, United States MaineHealth Full time

    Coding Audit Education and Quality Assurance Manager RoleThe 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...


  • Scarborough, Maine, United States MaineHealth Full time

    Job SummaryFully remote with flexible hours, the Coding Audit Education and Quality Assurance Manager oversees a team of professionals responsible for medical audit reviews, analysis, and compliance reporting. This role involves supervising the provision of audit reviews and corresponding analysis to support acceptable and compliant charging, billing, and...


  • Scarborough, Maine, United States Blue Star Partners, LLC Full time

    Job Title: Training Support SpecialistJob Summary:We are seeking a highly skilled Training Support Specialist to join our team at Blue Star Partners, LLC. The successful candidate will be responsible for providing training support and expertise to employees to ensure continued compliance with Quality System and administration of the divisional Learning...


  • Scarborough, Maine, United States New England Life Care Full time

    Job SummaryNew England Life Care is seeking a skilled Hybrid Biller to join our team. As a Hybrid Biller, you will be responsible for the billing of insurances and patients, ensuring accurate and timely reimbursement.Key ResponsibilitiesAchieve performance appraisals with 'meets expectations' or betterDemonstrate independence and competence in reviewing and...

  • Accounting Manager

    4 weeks ago


    Scarborough, Maine, United States ProSearch Maine Full time

    Job SummaryWe are seeking a highly skilled Accounting Manager to join our team at ProSearch Maine. The successful candidate will be responsible for overseeing the accounting functions of our company, ensuring accurate and timely financial reporting.Key ResponsibilitiesSupervise a small team of accounting staffEnsure accurate and timely financial...


  • Scarborough, Maine, United States Retail Business Services Full time

    Job Title: Employment Labor AttorneyA key member of the Retail Business Services LLC legal team, the Employment Labor Attorney will provide critical guidance and support to Human Resources and business leaders on employment, labor, and benefits law. This role plays a pivotal part in ensuring the companies operate within legal parameters while achieving...


  • Scarborough, Maine, United States Retail Business Services Full time

    Job SummaryThe Employment Labor Attorney will provide legal advice and support to Retail Business Services LLC and its affiliated companies in the United States. The Attorney will address complex employment law issues, manage litigation and disputes, and monitor relevant legal developments. The ideal candidate will have a J.D. degree, state bar license, and...


  • Scarborough, Maine, United States Brambles Full time

    Job DescriptionSchedule:First Shift - 7am to 3:30pmPosition Purpose:The HSE Lead plays a crucial role in ensuring a safe working environment for all production employees. This involves enforcing Safety First compliance, partnering with plant leadership to execute health, safety, and environmental initiatives, and performing safety audits to ensure adherence...


  • Scarborough, Maine, United States Facility MaineHealth Full time

    Job SummaryThis leadership role is responsible for overseeing a team of medical professionals at Facility MaineHealth, a reputable healthcare institution in Maine.Key ResponsibilitiesServe as a clinical supervisor, guiding and mentoring MA, RN, and PSR staff to ensure exceptional patient care.Develop and implement strategies to enhance the quality of care...


  • Scarborough, Maine, United States Crossroads for Women, I Full time

    Job SummaryCrossroads for Women, I is seeking a highly organized and detail-oriented HR Coordinator to support the organization's staff and leadership. The successful candidate will provide comprehensive HR administrative and project management assistance, ensuring seamless recruitment and onboarding processes.The ideal candidate will possess strong...

  • Nurse Care Manager

    4 weeks ago


    Scarborough, Maine, United States Genesis Healthcare Services Full time

    We are seeking a skilled Registered Nurse to join our clinical team at Genesis HealthCare Services. As a Registered Nurse, you will play a vital role in delivering high-quality patient care and making a meaningful difference in the lives of our patients and residents.Key Responsibilities:Manage patient care by performing nursing assessments and collaborating...


  • Scarborough, Maine, United States World Insurance Associates, LLC. Full time

    Job SummaryWe are seeking a highly skilled Commercial Lines Account Manager to join our team at World Insurance Associates, LLC. As a key member of our team, you will be responsible for managing a high-volume book of insurance business, ensuring all required tasks are completed accurately and on-time.Key Responsibilities:Effectively manage a portfolio of...


  • Scarborough, Maine, United States World Insurance Associates, LLC. Full time

    Job DescriptionAt World Insurance Associates, we are seeking a highly skilled Commercial Lines Associate Account Manager to join our team. This role will support the Account Executive in managing a book of Commercial Lines Property & Casualty Insurance business, ensuring all required tasks are completed accurately and on-time.Key Responsibilities:Assist...

  • Nurse Care Manager

    3 weeks ago


    Scarborough, Maine, United States Genesis HealthCare Full time

    At Genesis HealthCare, we're dedicated to delivering high-quality healthcare and compassion to our patients and residents. As a Registered Nurse, you'll play a vital role in our clinical team, working closely with physicians, social workers, and other healthcare professionals to provide exceptional care.Key Responsibilities:Conduct thorough nursing...


  • Scarborough, Maine, United States Bass Pro Shops Full time

    Job Summary:The Asset Protection Coordinator is a vital role within Bass Pro Shops, responsible for maintaining and monitoring all asset protection, security, compliance, and safety-related functions within a facility. This position plays a crucial part in reducing shrink, maintaining accurate inventory, ensuring compliance, and creating a safe and secure...


  • Scarborough, Maine, United States World Insurance Associates LLC Full time

    Job SummaryWorld Insurance Associates LLC is seeking a highly skilled Account Executive to join our team. As a key member of our Commercial Lines team, you will be responsible for managing a high-volume book of business, ensuring all tasks are completed accurately and on-time. This includes growing client loyalty by building positive relationships and...


  • Scarborough, Maine, United States Residence Inn PortlandScarborough Full time

    Job Summary:The General Manager is responsible for overseeing the overall operations of the Residence Inn Portland/Scarborough, ensuring that the hotel maintains high standards of quality and service. This includes managing the hotel's financial performance, supervising staff, and implementing strategies to drive revenue growth and improve guest...

  • Project Manager I

    4 weeks ago


    Scarborough, Maine, United States Blue Star Partners LLC Full time

    Job Title: Project Manager IJob Description:At Blue Star Partners LLC, we are seeking a skilled Project Manager I to lead and direct activities and personnel associated with small to large-scale projects, focusing on non-IT business applications and disciplines.Key Responsibilities:* Manage and direct activities and personnel associated with small to...


  • Scarborough, Maine, United States RAYUS Radiology Full time

    RAYUS Radiology is seeking a skilled Technical Operations Manager to oversee the technical operations of multiple centers. The ideal candidate will have a strong background in managing technical operations, staff management, and budget management. The Technical Operations Manager will be responsible for planning, implementing, and maintaining programs,...


  • Scarborough, Maine, United States Abbott Full time

    At Abbott, we are seeking a highly skilled Supplier Quality Manager to join our team. This role is responsible for managing the administration of departmental activities of Supplier Quality Assurance while maintaining compliance to, and driving continuous improvement of, related quality assurance programs, policies, process, procedures, and controls.Key...