[Remote] Manager, Auditing and Monitoring

Note: The job is a remote job and is open to candidates in USA. Cardinal Health is a healthcare solutions company dedicated to integrity and compliance. They are seeking a skilled Manager for Auditing and Monitoring to oversee compliance standards and manage billing audits in their At-Home Solutions business, ensuring adherence to healthcare regulations and fostering collaboration across teams.

Responsibilities

• Provides compliance-related expertise and advice to Revenue Cycle management and other business teams with respect to day-to-day operations, including, without limitation, advice on Medicare and Medicaid DMEPOS supplier billing requirements, local coverage determination requirements, Medicare DMEPOS Supplier and Quality Standards, and other payor requirements
• Serves as liaison with third party government contractors conducting audits as well as managing a small internal billing compliance team
• Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to DMEPOS supplies billing and/or medical necessity reviews and other high-risk areas as appropriate
• Leads data analytics on audit outcomes; identifies and reviews audit trends and makes recommendations on remedial action to address such trends
• Evaluates the appropriateness of items billed based on supporting record documentation and ensures documentation conforms to CMS and/or payor requirements
• Prepares written reports of audit findings, with recommendations, and presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records
• Collaborates with the Legal team to conduct risk assessments to define audit priorities based on previous audit findings, management priorities, national normative data, CMS initiatives, OIG work plans and advisories and healthcare industry best-practices
• Develops and implements compliance training to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures
• Plans and conducts regular compliance training for Revenue Cycle team members, as needed
• Provides feedback and training for staff regarding potential claim deficiencies
• Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements
• Supports the overall workplan of the Compliance Department
• Interacts with subordinates, peers, customers and suppliers at various management levels and may interact with senior management
• Interactions normally involve resolution of issues related to operations and/or projects
• Gains consensus from various parties involved
• Other duties as assigned

Skills

• Familiarity with key laws, regulations, and sub-regulatory guidance that affects DMEPOS businesses and by federal and state government programs, for example, fraud and abuse (Anti-Kickback Statute, False Claims Act, Civil Monetary Penalties Law, Stark, and Beneficiary Inducement Statutes); works collaboratively with the Legal Team to help advise the At-Home Solutions business
• Expert-level knowledge of Medicare and Medicaid billing and documentation requirements; healthcare compliance audit methodology, principles and techniques; CMS Medicare manuals; DMEPOS reimbursement and repayment; confidentiality standards
• Ability to interpret and apply coverage determination, documentation and coding rules, laws and regulations and to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation
• Strong attention to detail with an emphasis on organizational and analytical skills
• Understanding of institutional risks and appropriate judgment to use a risk-based approach in planning and executing duties
• Ability to communicate complex and potentially sensitive issues to all levels of management including senior leadership
• Prompt and efficient ability to manage shifting priorities, demands and timelines using analytical and problem-solving capabilities
• Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment
• Excellent problem-solving skills with self-starter qualities, enabling management of responsibilities to function effectively and efficiently
• Strong communication and presentation skills
• Proficiency in MS Word, Excel, PowerPoint, and Outlook
• Manages department operations and supervises professional employees, front line supervisors and/or business support staff
• Participates in the development of policies and procedures to achieve specific goals
• Ensure employees operate within guidelines
• Decisions have impact on work processes, and outcomes
• Ability to work in a team environment with the ability to handle multiple audits at once
• Knowledge of claim lifecycles and revenue cycle management
• Knowledge of CMS Local Coverage Determination policies, and various payor requirements
• Professional auditing experience
• Exceptional Customer Service Skills
• Proven interpersonal communication skills
• Excellent time management, personal integrity and ability to maintain confidentiality
• 8-12 years of experience, preferred
• Bachelor's degree in related field, or equivalent work experience, preferred
• 7+ years of related work experience supporting compliance programs in DMEPOS suppliers, coding and medical necessity expertise, preferred
• Related work experience with Brightree, preferred

Benefits

• Medical, dental and vision coverage
• Paid time off
• Health savings account (HSA)
• 401k savings plan
• Access to wages before pay day with myFlexPay
• Flexible spending accounts (FSAs)
• Short- and long-term disability coverage
• Work-Life resources
• Paid parental leave
• Healthy lifestyle programs

Company Overview

Company H1B Sponsorship