Healthcare Compliance Audit Manager

20 hours ago


Scarborough, Maine, United States MaineHealth Full time
Job 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 compliance reporting. This role involves supervising the provision of audit reviews and corresponding analysis to support acceptable and compliant charging, billing, and documentation practices for the MaineHealth system.

Key Responsibilities
  • Directly supervise the provision of medical audit reviews and corresponding analysis to support acceptable and compliant charging, billing, and documentation practices for the MaineHealth system.
  • Oversee and validate statistical reports and analysis of audit findings, delivering them to Coding Leadership, Central Business Office Leaders, and the MaineHealth Audit Committee with subsequent process improvement recommendations.
  • Assist with responses and education to the ongoing corporate risk audit process and the development of the educational follow-up work plan, as required.
  • Collaborate with healthcare professionals to ensure compliance with regulatory guidelines and industry standards.
  • Develop and implement effective audit and compliance strategies to ensure the highest level of quality and accuracy in coding and billing practices.
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, with prior management experience preferred.
  • Must have in-depth knowledge of hospital, medical, and behavioral practice organizational structure, as well as CAH, RHC, and FQHC experience.
  • Ability to analyze and interpret clinical and administrative healthcare data, communicate at a college level, and possess leadership and analytical skills.
About MaineHealth

MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services.



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