Director of Compliance Audits - Healthcare Legal and Regulatory (Eastern United States resident)

Director Of Compliance Audits

The Director Of Compliance Audits ensures the integrity and accuracy of billing practices within the organization. The Director will work closely with the AVP, Revenue Management Compliance in developing and implementing a compliance audit program that adheres to regulations and industry standards, focusing on hospital and professional billing compliance. This role involves overseeing auditing activities to ensure compliance with federal guidelines and regulations related to coding and billing, managing a team of auditors, conducting risk analysis, and providing guidance on documentation and coding standards. Additionally, the Director conducts risk analysis and collaborates with various departments to manage billing risks.

Job Duties :

• Manages, plans, organizes, and ensures the completion of compliance audit activities in accordance with the Compliance Work Plan.
• Provides oversight of audits, including audit scope, objectives, and final reports.
• Coordinates the development and implementation of all corrective action and improvement plans with critical attention to performing a root cause analysis.
• Works in collaboration with the Revenue Management Compliance AVP to develop and implement strategic goals for the audit team.
• Directly supervises Revenue Management Compliance audit staff, including supervisors and auditors for hospital and professional auditing.
• Prepares responses to governmental audits, evaluate findings, and manage the appeals process.
• Manages audits conducted by vendors and payers, providing status reports to senior leadership.
• Provides guidance and serve as an institutional resource for Geisinger leadership, management and medical staff regarding federal payer laws and regulations impacting billing compliance.
• Mentors and coaches audit staff, facilitate audit staff training opportunities and support career growth. Work with management team members and Human Resources to ensure performance issues are addressed.
• Proactively communicates relevant information such as issues, problems and successes within the compliance realm to Revenue Management Compliance AVP.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details :

One of the following coding or auditing certifications are required (CCS, CPC, RHIA, RHIT or CPMA).

Education : Bachelor's Degree-Related Field Of Study (Required), Master's Degree-Related Field Of Study (Preferred)

Experience : Minimum of 8 years-Related work experience (Required), Minimum of 5 years-Managerial / Supervisory (Required)

Skills : Clinical Documentation, Communication, Critical Thinking, Data Presentations, Organizing, Problem Solving, Team Leadership

Our Purpose & Values : Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.