Manager, Compliance (Medical Billing)

Legal & Compliance Worcester, Massachusetts


Position at UMass Memorial Health Care

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 # 201993
Title: Manager, Compliance
Department: Corporate Compliance
Location: UMass Memorial Medical Center – 1 Biotech Park, Worcester, MA.

Position Summary:

Manages a team responsible for conducting UMass Memorial Health Care (UMMHC) compliance auditing and monitoring (inpatient and outpatient coding and billing audits) which includes, but is 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 physician and/or fraud units. Provides compliance education and communications to caregivers and/or management.

Major Responsibilities:

  • Manages proactive compliance audits of inpatient and outpatient documentation, coding and billing in accordance with the 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.
  • Manages the audit documentation electronic record-keeping system.
  • Coordinates responses to government or other external audit or investigative requests or consultant audits to ensure responses are submitted in a timely manner, with appropriate tracking and reporting.
  • Provides compliance training in Code of Ethics and Business Conduct, coding, billing, or other compliance related topics as needed.
  • Researches and remains current on inpatient and outpatient documentation, coding and billing rules.
  • Works with other functions, as appropriate, to develop materials based on audit findings for use in education and communication to clinicians and/or providers as well as administrators, coders, and billing staff.
  • Assists the Chief Compliance Officer- Revenue Cycle in the development of an annual audit plan and in the prioritization of audits on an ongoing basis.
  • Researches topics, assimilates information, and communicates effectively in person and in writing.

Position Qualifications:

License/Certification/Education Required:

  • 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 services, health care regulations, medical necessity requirements, clinical terminology and coding guidelines such as ICD-10-CM and CPT-4.
  • Strong PC literacy (Microsoft Word, Excel, SharePoint, PowerPoint and EPIC).
  • Strong verbal, written and communication skills.

Standards of Respect:

Standards of Respect
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.