Medical Compliance Audit Manager - Audit & Compliance

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Portland, ME

Industry: Healthcare

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5 - 7 years

Posted 116 days ago

Job Details: MaineHealth, the parent company of MaineMedicalCenter, has an immediate opening for a BillingCompliance Manager. As a key member of theAudit & Compliance Services Team, this position manages the billing compliance and medicalaudit functions for MaineHealth and its affiliates. This position coordinates various complianceaudits, conducts educational sessions and serves as a primary contact regarding billing compliance issues for MaineHealth and its affiliates.

Qualified candidates will possess a certified professional coder or an equivalent designation and have prior related managerial experience. Excellent written and verbal communication ability, and strong organization and analytical skills are also required.

General Summary

Reporting to the Vice President of Audit & Compliance Services, this position manages the daily billing compliance audit functions of MaineHealth. Under minimal supervision, the Billing Compliance Manager is responsible for leading audits of MaineHealth’s billing processes to ensure that coding, billing and medical record documentation supports billing compliance with all Federal and State regulations and commercial payor contract terms. The Billing Compliance Manager assists the Vice President with both the ongoing corporate risk assessment process and the development of the annual Department work plan. The Billing Compliance Manager supervises a professional staff of six.

Minimum Knowledge, Skills and Abilities Required

  1. Demonstration of integrity, maturity, dependability, stamina, positive attitude and enthusiasm in the performance of responsibilities.
  2. Ability to speak and write effectively; communicating clearly through work paper schedules, memorandums, auditreports, and discussion with management personnel and the MaineHealth Audit Committee, as necessary.
  3. Analytical ability necessary to properly lead and conduct billing compliance audits and prepare necessary reports with complete analysis, results and recommendations.
  4. Ability to organize and prioritize workload to meet deadlines.
  5. Five plus years of progressive billing compliance auditexperience. Certified Professional Coder certification or equivalent required. Prior management experiencedesired.
  6. A Bachelor’s degree in Accounting, Business Administrations, or a related business field.
  7. Maintains continuing professional education as required to perform responsibilities of the job.