Compliance Audit Manager

Overview

Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.

Compliance Audit Manager

Under the direct supervision of the Director, Compliance this position contributes to the Bon Secours Mercy Health mission and vision by managing acute and provider revenue cycle compliance initiatives to identify and mitigate emerging governmental and payer revenue cycle compliance risks to the ministry. This position assists the Director of Compliance to perform tracking, trending, and reporting of data analytics to help identify risks and establish proactive monitoring initiatives and is responsible to manage the performance of assigned work plan audits, management requests, due diligence reviews and responses to governmental audits and inquiries.

This is a remote/work from home position. Hire must live be willing to work eastern time zone hours.

• Works collaboratively with the Director, Compliance on creating auditing and monitoring protocols that align with Bon Secours Mercy Health’s overall compliance audit and compliance responsibilities relative to acute and physician revenue cycle services performed for Bon Secours Mercy Health.
• Oversees acute and provider compliance audits including work plan items, management requests, Merger and Acquisition due diligence coding audits and assessments, and responses to governmental audits and inquiries.
• Assesses and makes recommendations to improve internal controls and policies and procedures for both acute and provider Revenue Cycle operations including the development of SOPs.
• Develops acute and provider compliance monitoring and audit protocols specific to revenue cycle compliance risk areas highlighted by the Office of Inspector General (OIG), Medicare, State Medicaid, State Insurance Fraud, Managed Care or Governmental Value-Based payment programs or other enforcement agencies on behalf of Bon Secours Mercy Health.
• Coordinates periodic review and analysis of Bon Secours Mercy Health provider claims denial reports, operational assessment reports, internal quality control reviews, internal and external third-party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues.
• Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect and trend potential claims and billing compliance issues.
• Assists in the development of corrective action plans (CAP), oversight tools and technical edit enhancements to support acute and physician revenue cycle services operational efforts. Assists in tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
• Maintains awareness of regulations and current industry changes that may impact healthcare physician revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
• Ensures that the Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status.
• Develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities.

This document is not an exhaustive list of all responsibilities, skills, duties,…