CODING COMPLIANCE AUDIT MANAGER

At Trinity Health, we are called to be innovative in improving health care delivery, to help restore well-being, to relieve and prevent suffering, and to be a community of persons in service to others. With 43 hospitals in 7 states, Trinity Health is the fourth largest Catholic health system in the US.

We are seeking an experienced Coding Compliance Audit Manager to join our team of talented and dedicated associates.

 POSITION PURPOSE

 

Manages, oversees and monitors the audit management process as part of the Recovery Audit Contractors (RAC) Audit.  Works in collaboration with the Chief Compliance Officer and VP, Quality Health Record and Coding. Responsible for managing, overseeing and implementing audit activities performed by the RAC Central Operations team. Oversees and coordinates audits of RAC denials and identification of audit appeal strategies. Develops and implements audit plans and prepares correspondence, reports and presentation materials for Trinity Health and Ministry Organization leadership regarding status of audit activities. Oversees concepts, leading practices, serves as subject matter expert and possesses advanced knowledge of coding, billing, DRG coordination, reimbursement and compliance management as well as specific laws and regulations imposed on health care systems. Manages the delivery of in-service educational programs and the development of informational materials and workflow tools that support Ministry Organizations (MOs) integrating compliance in their operations.  Assists the VP, Quality Health Record and Coding, Chief Compliance Officer and HIM directors throughout the UEM in the development and implementation of RAC audit appeal strategies and identifying and delivering improvement opportunities.  Leads MO RAC Response teams in the development and implementation of best practices and policies.

 

SOME ESSENTIAL FUNCTIONS INCLUDE

 Assists the VP, Quality Health Record and Coding and Chief Compliance Officer in the development, implementation and maintenance of an effective audit management program and related processes.

 

· Works with designated audit response teams at the Ministry Organizations in implementing leading practice improvement areas to respond to RAC audit target areas. 

 

 

· Manages and oversees implementation of RAC audit denials and appeal defense operations and services.  Manages, coordinates and monitors RAC audit assignments as conducted by RAC Coding/Compliance Specialist throughout Trinity Health and the UEM.

 Oversees the design, development and implementation of educational programs, information materials and tools compliance and process improvement.

 Manages, selects, and promotes ongoing development of staff.

 Provides support to VP, Quality Health Record and Coding and senior leaders by coordinating special assignments.

 

 Responsible for ensuring the development and implementation of an audit database and standard reporting tool to track and report audit appeal turnaround time.

 Keeps abreast of the latest developments, advancements and trends in coding, billing and reimbursement as well as specific laws and regulations imposed on health care .

 Maintains a working knowledge of applicable Federal, State and local laws and regulations, including those related to Medicare and Medicaid.

 

 

MINIMUM QUALIFICATIONS

 

·  Bachelor’s degree in Health Information Management (HIM), Business Administration or related field or an equivalent combination of education and experience. Ten (10) years experience serving in a health care organization. Must have an in-depth knowledge of health care audit experience.

 

·  Must be either a Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT), and inpatient certified coder (CCS).

 

· Must have Ten (10) ten years of progressive experience in various hospital functions, such as coding, DRG coordinator, billing and reimbursement, ten (10) of which should be in a lead and supervisory role.

 Must possess strong knowledge and practice of specific laws and regulations related to coding, billing and reimbursement imposed on health care systems by various agencies.

 

·  Must have knowledge of coding guidelines.  Must be able to demonstrate an advanced knowledge of both ICD-9-CM and CPT-4 coding procedures.

 

·  Must have a proficient knowledge of Medicare, Medicaid and other third party payer documentation, coding and billing regulations. Working knowledge of Medicare Conditions of Participation required.

 

·  Must possess excellent organizational and planning skills, including the ability to prioritize functions and monitor productivity.

 

·  Must possess strong written and verbal communication skills in order to communicate in clear, concise terms to management at all levels, including the ability to articulate complex regulatory information in layman’s terms.

 

·  Must possess computer skills, especially with Microsoft Word, Access and excel applications.  Must be able to use Internet and other resource applications for research purposes and provide documentations that supports regulations quoted in audits.

 Demonstrated strong analytical and conceptual skills.

 

·  Demonstrates strong written and verbal communication skills.

 Demonstrates strong management and leadership skills.

 Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.

 Must be able to travel to the various Trinity Health sites as needed (+/-30%)

 

 

Trinity Health offers a comprehensive benefits package including medical, dental, vision, matching 403(b), paid time off, FSA, STD, LTD, life insurance, pension, and tuition reimbursement.

 

FOR MORE INFORMATION ON TRINITY HEALTH, AND TO APPLY ONLINE, GO TO www.trinity-health.org AND FOLLOW THE CAREERS LINK FOR TRINITY HEALTH POSITIONS IN MICHIGAN.

OR GO DIRECTLY TO http://trinityhealth.jobscience.com/JsrApp/