Manager Hospital Compliance Audit

Legal & Compliance Worcester, Massachusetts


Position at UMass Memorial Health

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition # 215560
Title: Manager Compliance, Hospital Billing
Department: Compliance
Posting Date: 7/2/21
Shift: Days
Status: Exempt
Hours: 40
Shift Length: 8
Location: UMass Memorial Medical Center, Worcester, MA.

Position Summary:

This position manages the audit team responsible for conducting UMMHC hospital inpatient and outpatient coding and billing audits which includes, but not limited to, audit planning, conducting the audit, maintaining documentation, implementing corrective actions, drafting reports, preparing reports, and presenting findings as related to internal billing compliance audits. This position also manages responses to external government audits or commercial audits from payer fraud units.
Major Responsibilities:

  • Manages proactive compliance audits of UMMHC hospital inpatient and outpatient documentation, coding and billing in accordance with the UMMHC Compliance Work Plan and other identified risks to assess compliance with Medicare, Medicaid and other third-party coding and billing requirements.
  • Prepares and presents written audit plans, and reports of audit findings and recommended corrective actions.
  • Oversees the tracking of management responses to audits and the completion of corrective actions.
  • Identifies charge corrections and refunds resulting from audits.
  • Develops, manages and updates audit policies, procedures, tools, and templates in collaboration with leadership.
Position Qualifications:
  • Bachelor’s degree.
  • American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) certification (Registered Health Information Administrator (RHIA), Registered Health Information technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder/Certified Outpatient Coder (CPC/COC)) to demonstrate coding expertise.
Experience/Skill Required:
  • Minimum five (5) years of billing, coding or documentation audit experience in a health care provider or payer organization, including a minimum of one (1) year of supervisory/management experience
  • Working knowledge of auditing techniques and auditing standards.
  • Working knowledge of various payment methods for inpatient and outpatient hospital services, health care regulations, medical necessity requirements, clinical terminology and coding guidelines for ICD-10-CM/PCS, CPT-4, HCPCS.
  • Strong PC literacy (Microsoft Word, Excel, SharePoint, and PowerPoint).
  • Strong verbal, written and communication skills.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Standards of Respect: