Manager of Corporate Integrity - Audits (Hospital and Professional)

Description

The Manager, Integrity reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

• Primarily focus is on professional audits, issues, and projects. Experience in the professional coding and billing domain highly encouraged.
• Develop, coordinate, and oversee proactive professional and hospital audits to test compliance with established laws, regulations, and/or policies.
• Assist in the development, monitoring, and validation of corrective action plans.
• Leverage technology to support efficient, risk-based, compliance auditing and monitoring program.
• Assist the Director and Program Director in establishing annual audit priorities.
• Assist the Director and Program Director in establishing process for prioritizing unplanned audit activities.
• As needed, oversee external consultants supporting the compliance audit program.
• Coordinate with Internal Audit with respect to audit activities.
• Coordinate and perform proactive audits to test compliance with established laws, regulations, and policies. Assist in the development of corrective action plans when areas of opportunity are identified.

Additional Responsibilities:

• Keep current on regulatory requirements (state, local, and federal) and compliance best practices and be able to determine and articulate organizational impact.
• Implement processes to ensure compliance with applicable laws, regulations, and standards.
• Accountable for the achievement of CCI department annual goals and objectives.
• Directly supports the development and implementation of the annual CCI work plan, including the delegation of planned activities to assigned staff based on skill set and required expertise.
• Utilize project management tools and techniques to ensure timely and high quality execution of CCI priorities.
• Establish and maintain effective communications regarding assigned projects and compliance issues or concerns.
• Create and execute project work plans for assigned activities.
• Support VP, Integrity and Directors in identifying areas of potential compliance risk or exposure.
• Supervise CCI staff, as assigned.
• Support VP, Integrity and Directors in preparing and issuing various communications to NMHC management and the Audit Committee, including preparation of quarterly reports and dashboards.
• Serve as a consultant to management on compliance issues.
• As required, work collaboratively with government and regulatory agencies (e.g., Office of Inspector General).
• Collaboratively coordinate appropriate response plan for problem resolution. Follow-up to ensure resolution is complete/corrective action measures taken and appropriate information is disseminated, as necessary.
• Utilize analytic skills to assess trends, patterns and conduct root cause analyses to support implementation of sustainable corrective actions for identified compliance issues.
• Perform other related duties as required.

Qualifications

Required :

• Bachelor's degree.
• Minimum of three years of experience in healthcare (e.g., consulting, health system, or payer) or in a compliance role (healthcare or non-healthcare).
• Demonstrated ability to work with various levels within the organization regarding confidential information and maintain sensitive data.
• Proficiency in data analysis, documentation, and report development.
• Strong interpersonal and communications skills. Ability to work collaboratively and communicate with others in a clear, concise, and professional manner on the telephone and in person, as well as, demonstrate use of good written and verbal communication skills.
• Strong analytical and problem solving skills emphasizing solutions that comply with regulations and fit the needs and culture of the organization. Strong project management and facilitation skills, attention to detail, and the ability to direct and motivate people.
• Knowledge and experience in using Word, Excel, PowerPoint, Access and similar office programs.

Preferred :

• Certified Healthcare Compliance (“CHC”) certification.
• Attorney and/or JD with 3 to 5 years of experience.
• Management experience.
• Master’s degree in Health Care Management or related field.
• Experience in developing corporate policies and training programs.
• Knowledge of and experience with coding/utilization, billing, and medical records.

Equal Opportunity

All your information will be kept confidential according to EEO guidelines.