Compliance Audit Manager (Hospital)

Legal & Compliance Worcester, Massachusetts


Position at UMass Memorial Health Care

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 # 193149
Title: Hospital Compliance Audit Manager 
Department: UMMMC Corporate Compliance
Location: UMass Memorial Health Care – 1 Biotech Park, Worcester, MA
Position Summary:
This position is primarily responsible for leading and conducting UMMMC inpatient and outpatient coding and billing audits including, but not limited to: audit planning, conducting the audit, maintaining documentation, implementing corrective actions, drafting reports, preparing reports, and presenting findings. This position is also the system administrator, super user, and content expert for the MedeAnalytics compliance audit platform. This position reports to the UMMMC Chief Compliance Officer with a dotted line to the UMMHC Revenue Cycle Chief Compliance Officer.
Position Qualifications:

  • Bachelor's degree with three years of relevant experience, or a minimum five years of billing, coding or documentation audit experience in a health care provider or payer organization is required.
  • AHIMA or AAPC certification (RHIA, RHIT, CCS, or CPC/COC) to demonstrate coding expertise is required.
  • Working knowledge of auditing techniques and auditing standards is required.
  • 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).
  • Experience using one or more compliance audit software platforms to identify risks and develop audit universes is preferred.
 Major Responsibilities: 
  • Plan and perform proactive compliance audits of UMMMC hospital inpatient and outpatient documentation, coding and billing in accordance with the UMMMC Compliance Work Plan and other identified risks in order to assess compliance with Medicare and other third party coding and billing requirements.
  • Prepare, and present as needed, written audit plans, and reports of audit findings and recommended corrective actions.
  • Track management responses to audits and the completion of corrective actions.
  • Identify charge corrections and refunds resulting from audits.
  • In collaboration with management, develop, manage and update audit policies, procedures, tools and templates.
  • Manage the hospital audit documentation electronic record-keeping system.
  • System administrator, super user, and content expert for the MedeAnalytics compliance audit platform.
  • Assist as requested with responses to government or other external audit or investigative requests.
  • Provide compliance training in UMass Memorial Code of Ethics and Business Conduct, coding, billing, or other compliance related topics as needed.
  • Research and remain current on hospital inpatient and outpatient documentation, coding and billing rules.
  • Develop materials in collaboration with other functions as appropriate, for use in education and communication derived from audit findings for feedback to clinicians, administrators, coders, and billing staff.
  • Participate in the development of an annual audit plan and in the prioritization of audits on an ongoing basis.
  • Research topics, assimilate information, and communicate effectively in person and in writing.
  • Maintain licensure or certification by participating in continuing education.
  • Comply with established departmental policies, procedures and objectives.
  • Attend a variety of meetings, conferences, seminars as required or directed.
  • Demonstrate use of Quality Improvement in daily operations.
  • Comply with all health and safety regulations and requirements.
  • Respect diverse views and approaches, and contribute in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
  • Perform other similar and related duties as required or directed.
 All responsibilities are essential job functions.
We’re striving to make respect a part of everything we do at UMass Memorial – for our patients and for each other. We’re expecting that our new caregivers practice our six Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind, to help us make respect a part of how we take care of business everyday.

As an equal opportunity and affirmative action employer, UMMHC recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.