Director of Hospital Billing, Compliance, Government Audits & Appeals - Remote | WFH - Get It Recruit - Healthcare
Lower Merion Township, PA 19004
About the Job
Our organization is dedicated to a mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Joining our team means collaborating with top clinical, technical, and business professionals across all disciplines.
Today, someone in our organization will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Position: Director for Hospital Billing Compliance and Government Audits/Appeals
Department: Office of Billing Compliance
Location: 150 Monument Rd., Bala Cynwyd (Remote)
Hours: M-F, 8:30AM - 5:00PM (must live a reasonable distance from location)
Position Summary:
The Director for Hospital Billing Compliance and Government Audits/Appeals oversees the planning, coordinating, scheduling, and performance of annual chart reviews and focused audits, including high-risk areas and responses to internal and external allegations. This role is essential in developing a statistical and audit sampling strategy to identify and address compliance, financial, and reputational risk areas across various care settings. Additionally, the Director leads the external government audit response and appeal process for hospitals, pharmacies, home infusion, home care, hospice services, and all practice plans within the organization.
Key Responsibilities:
Audit Planning and Execution:
Direct the audit plan, covering inpatient DRG, outpatient APC, home health/hospice agencies, inpatient rehabilitation units, and specialty care hospitals/centers.
Develop annual audit plans based on identified risks.
Conduct data mining to identify audit sample claims (e.g., OIG targets, RAC initiatives, benchmark data).
Analyze audit results, prepare formal reports, and recommend corrective actions.
Compliance Education and Training:
Prepare and conduct annual compliance education sessions for staff across all facilities.
Develop focused audits and educational programs based on audit results.
External Audit Management:
Lead the response to external government and third-party audits (e.g., RAC, MAC, ZPIC, OIG).
Chair the External Audit Task Force and coordinate interdisciplinary audit efforts.
Monitor and implement new industry developments affecting audit processes.
Team Leadership and Development:
Supervise compliance analysts, senior compliance analysts, nurse auditors, and analysts.
Recruit and retain talented team members, and develop succession and contingency plans.
Conduct performance evaluations and provide guidance and support to the team.
Collaboration and Communication:
Work collaboratively with various departments to achieve favorable financial outcomes related to external audits.
Serve as a liaison to CMS, RAC, and other governmental audit contractors.
Manage compliance information, notify leadership of pertinent issues, and investigate reported issues.
Technical Expertise:
Subject matter expert in ICD-10/CPT/HCPCS coding, medical necessity, and appeal activity.
Oversee the review and validation of technical charges within the Charge Description Masters (CDM).
Participate in the CDM Maintenance Committee and provide recommendations for charge capture improvements.
Minimum Requirements:
Education and Experience:
Bachelor's degree (preferably in Health Information Management or related field).
At least 5 years of experience in hospital coding, DRG and APC analysis, and statistical analysis.
Master's degree in Nursing, Health Administration, or related field preferred.
Previous supervisory or management experience preferred.
Licenses and Certifications:
RHIT, RHIA, CCS, or CPC certification required.
AHIMA or AAPC membership required.
Skills and Abilities:
Strong written and verbal communication skills.
Ability to manage and execute projects efficiently and cost-effectively.
Strong leadership and critical thinking skills.
Proficiency in medical record review and documentation requirements.
Experience with ICD-10-CM/PCS and CPT/HCPCS coding and Medicare reimbursement systems.
Knowledge of Medicare regulations and public speaking experience.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Familiarity with EPIC and electronic medical records.
Additional Information:
As part of our COVID-19 response, this position may currently offer partial or full remote work. In the near future, it will require full or partial on-site work.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Our employees are actively engaged and committed to our mission. Together, we will continue to make medical advances that help people live longer, healthier lives.
Equal Opportunity Employer:
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran, or any other status protected by applicable law.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour
Today, someone in our organization will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Position: Director for Hospital Billing Compliance and Government Audits/Appeals
Department: Office of Billing Compliance
Location: 150 Monument Rd., Bala Cynwyd (Remote)
Hours: M-F, 8:30AM - 5:00PM (must live a reasonable distance from location)
Position Summary:
The Director for Hospital Billing Compliance and Government Audits/Appeals oversees the planning, coordinating, scheduling, and performance of annual chart reviews and focused audits, including high-risk areas and responses to internal and external allegations. This role is essential in developing a statistical and audit sampling strategy to identify and address compliance, financial, and reputational risk areas across various care settings. Additionally, the Director leads the external government audit response and appeal process for hospitals, pharmacies, home infusion, home care, hospice services, and all practice plans within the organization.
Key Responsibilities:
Audit Planning and Execution:
Direct the audit plan, covering inpatient DRG, outpatient APC, home health/hospice agencies, inpatient rehabilitation units, and specialty care hospitals/centers.
Develop annual audit plans based on identified risks.
Conduct data mining to identify audit sample claims (e.g., OIG targets, RAC initiatives, benchmark data).
Analyze audit results, prepare formal reports, and recommend corrective actions.
Compliance Education and Training:
Prepare and conduct annual compliance education sessions for staff across all facilities.
Develop focused audits and educational programs based on audit results.
External Audit Management:
Lead the response to external government and third-party audits (e.g., RAC, MAC, ZPIC, OIG).
Chair the External Audit Task Force and coordinate interdisciplinary audit efforts.
Monitor and implement new industry developments affecting audit processes.
Team Leadership and Development:
Supervise compliance analysts, senior compliance analysts, nurse auditors, and analysts.
Recruit and retain talented team members, and develop succession and contingency plans.
Conduct performance evaluations and provide guidance and support to the team.
Collaboration and Communication:
Work collaboratively with various departments to achieve favorable financial outcomes related to external audits.
Serve as a liaison to CMS, RAC, and other governmental audit contractors.
Manage compliance information, notify leadership of pertinent issues, and investigate reported issues.
Technical Expertise:
Subject matter expert in ICD-10/CPT/HCPCS coding, medical necessity, and appeal activity.
Oversee the review and validation of technical charges within the Charge Description Masters (CDM).
Participate in the CDM Maintenance Committee and provide recommendations for charge capture improvements.
Minimum Requirements:
Education and Experience:
Bachelor's degree (preferably in Health Information Management or related field).
At least 5 years of experience in hospital coding, DRG and APC analysis, and statistical analysis.
Master's degree in Nursing, Health Administration, or related field preferred.
Previous supervisory or management experience preferred.
Licenses and Certifications:
RHIT, RHIA, CCS, or CPC certification required.
AHIMA or AAPC membership required.
Skills and Abilities:
Strong written and verbal communication skills.
Ability to manage and execute projects efficiently and cost-effectively.
Strong leadership and critical thinking skills.
Proficiency in medical record review and documentation requirements.
Experience with ICD-10-CM/PCS and CPT/HCPCS coding and Medicare reimbursement systems.
Knowledge of Medicare regulations and public speaking experience.
Proficiency in Microsoft Word, Excel, and PowerPoint.
Familiarity with EPIC and electronic medical records.
Additional Information:
As part of our COVID-19 response, this position may currently offer partial or full remote work. In the near future, it will require full or partial on-site work.
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Our employees are actively engaged and committed to our mission. Together, we will continue to make medical advances that help people live longer, healthier lives.
Equal Opportunity Employer:
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran, or any other status protected by applicable law.
Employment Type: Full-Time
Salary: $ 20.00 Per Hour
Source : Get It Recruit - Healthcare