Manager- Compliance Audit (Compliance Dept.) - Detroit, MI
The Manager, Compliance Audit is responsible in collaboration with compliance leaders for implementing the HFHS Ethics and Compliance Program (Program) authorized by the Board of Trustees, Audit and Compliance Committee (Committee). The Manager's general duties and responsibilities encompass developing and implementing a program for auditing and monitoring to ensure HFHS items and services are documented, coded, charged, billed and reimbursed in compliance with federal and state laws and regulations, payer-specific policies and guidance, and HFHS policies (Standards); directing the Compliance Specialists in conducting program auditing and monitoring and ensuring the accuracy and quality of work; developing and maintaining reporting systems to effectively communicate results of auditing, monitoring and other compliance activities to Compliance Department leaders; and collaborating with members of the Revenue Cycle Department in assessing compliance with the Standards and recommending remediation for detected noncompliance. The Manager is directly responsible for certain high-risk compliance audits and other program development and compliance activities as assigned. The Manager reports directly to the Vice President, Compliance and Internal Audit.
EDUCATION AND EXPERIENCE:
- Seven years of experience in healthcare documentation, coding compliance, charging, billing, reimbursement matters and revenue cycle operations, and at three to five years of experience managing healthcare reimbursement compliance audits, preferably for a healthcare organization with hospitals and multiple lines of services.
- Demonstrated expertise in healthcare audit program operations; planning and overseeing healthcare reimbursement compliance audits; federal, state and payer-specific documentation, coding and billing policies and guidelines underlying healthcare reimbursement; healthcare documentation, billing and charging systems, including EPIC; and government program overpayment rules.
- A working knowledge of healthcare and hospital operations.
- Bachelor's degree required; compliance certification preferred