Manager - Compliance Audit Services

Job Description
The Manager - Compliance Audit Services is chiefly responsible for the day-to-day oversight, management of a compliance team, and support of the Compliance Audit Services team comprised of Compliance Auditors supporting Baptist Health Care's Inpatient, Outpatient, and Ambulatory service lines and facilities. The audit team is responsible for assuring the proper coding and billing of healthcare services furnished to beneficiaries of federally funded healthcare programs. In addition to the management and support of the audit team, the Manager - Compliance Audit Services is responsible for the execution of all compliance focal audits as identified on the annual work plan and as may be assigned by the Chief Compliance Officer, as well as supporting external audits as needed. The role requires a keen eye for detail, excellent communications and critical thinking skills, and a commitment to maintaining the highest ethical standards.
This position is onsite in Pensacola, FL.
Responsibilities

• Conducts, manages, and oversees external and internal audits and audit team. Reviews and approves all audit reports prior to release of draft and final audit reports to audited providers and departments. Ensures all audit reports are prepared for executive management review. Maintains workpapers and related supporting documentation in accordance with professional standards.
• Works with the Chief Compliance Officer to develop Compliance Auditing plans based on thorough research on studies conducted by government agencies and professional organizations.
• Reviews all relevant programs and activities affected by industry regulations, including records, reports, and software. Recommends corrective actions and other changes to address procedures and practices that are not compliance with industry regulations.
• Serves as the primary auditor responsible for the timely and accurate completion of compliance focal audits as identified on the annual Compliance Audit Work Plan.
• Ensures adherence to and completion of the annual Compliance Audit Work Plan, the Provider Audit program, and all ad hoc audits as may be required or assigned from time to time to the audit team.
• Compiles reports on the results of external and internal audits and present the findings to departmental and company leadership teams. Presents audit findings and review corrective action requirements will all audited providers and departments consistent with BHC and Compliance Department policies and procedures.
• Liaises with the Baptist Health Care Internal Audit team to ensure alignment of audit functions and the receipt and oversight of corrective action plans resulting from audits performed by the Internal Audit team.
• Ensures assigned audits (Provider and Hospital IP/OP audits) are performed according to policy and quality standards.
• Is responsible for department's operational excellence; ensures department delivers quality services in accordance with applicable policies, procedures, and professional standards.
• Manage team members which include orientation, development and evaluation of personnel, and monitoring the provision of delivering quality services. Participates in the recruiting, interviewing and selecting of team members following policies, guidelines and applicable laws. Evaluates their performance relative to job goals and requirements. Provides coaching to staff, recommends in-service education programs, and ensures adherence to internal policies and standards.
• Is responsible for the fiscal management of department; assures proper utilization of organization's financial resources.
• Effectively communicates departmental, organization, and industry information to staff
• Assist in other duties as assigned to support the operational needs of the department and organization.
• May be required to remain on campus immediately before, during, and after severe weather and/or disasters

Qualifications
Minimum Education

• Bachelor's Degree Health Information Management, Five years of related experience maybe considered in lieu of degree, Other related field Required

Minimum Work Experience

• 7-9 years Health care compliance experience including coding compliance Required
• 5 years Health care Compliance Auditing of coding and billing practices Required
• 3 years Experience managing a team of corporate Compliance Auditors in a hospital or health system setting Required
• Experience with the following applications and systems: Healthicity, Altera Sunrise (formerly Allscripts), Hyland MRM, Clintegrity, and FinThrive Preferred

Licenses and Certifications

• Certified Coding Specialist (CCS_AHIMA) Upon Hire Required or
• Certified Coding Specialist-Physician-based (CCSP_AHIMA) Upon Hire Required or
• Certified Professional Coder (CPC_AAPC) Upon Hire Required or
• Certified Outpatient Coding (COC_AAPC) Upon Hire Required or
• Certified Professional Medical Auditor (CPMA_AAPC) Upon Hire Required and
• Certified in Healthcare Compliance (CHC_HCCA) Health Care Compliance Association within 1 Year Required

Required Skills, Knowledge and Abilities

• Strong knowledge of ICD-10/PCS/CPT/HCPCS coding and billing compliance (MS-DRGs/IPPS, APC/OPPS) with excellent analytical and data mining skills.
• Ability to effectively participate and supervise projects, plan and implement programs, and evaluate outcomes.
• Ability to effectively work directly with various levels of staff (including on-site and remote).
• Must possess strong communication skills, both written and verbal.
• Exhibits effective organizational skills, time management, and management of multiple priorities.
• Ability to make effective and persuasive presentations on complex topics to management and physicians.
• Ability to teach and mentor coders and physicians on complex coding systems.
• Ability to have an excellent balance of being highly productive and yet produce high quality work.
• Must be able to create strong arguments based on solid coding guidelines and audit practices.
• Ability to interpret federal and state regulations as they relate to coding and compliance.