Coding Audit Education and Quality Assurance Manager

4 days ago


Scarborough, Maine, United States MaineHealth Full time
MaineHealth Coding Audit Education and Quality Assurance Manager

Summary

Fully remote with flexible hours

The Coding Audit Education and Quality Assurance Manager oversees a team of professionals responsible for medical audit reviews, analysis, and reporting. This role ensures compliance with billing and documentation practices for the MaineHealth system. The manager validates statistical reports and delivers findings to leadership and the Audit Committee, providing process improvement recommendations.

Key Responsibilities:

  • Manage a team of DRG Validation Specialists/Educators, Outpatient Quality Compliance auditors, Clinical Coding Compliance auditors, and Behavioral Health Clinical Coding audit educators
  • Supervise the provision of medical audit reviews and corresponding analysis
  • Oversee and validate statistical reports and analysis of audit findings
  • Deliver findings to Coding Leadership, Central Business Office Leaders, and the MaineHealth Audit Committee
  • Assist with responses and education to the ongoing corporate risk audit process
  • Develop educational follow-up work plans as required

Requirements:

  • Bachelor's degree in Healthcare Administration, HIM, or a related business field
  • Possess one or more of the following certifications: CPC, COC, CPMA, CHC, CPCO, CCS-P, CCS, RHIA, RHIT, or CIC
  • Five or more years' progressive healthcare compliance audit and/or coding experience
  • Prior management experience preferred
  • 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

MaineHealth is a health system with hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this opportunity.



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