JOB SUMMARY

Strategic oversight of the internal audit function across the organization ensuring risk-based audit coverage and providing independent and objective assessment of the organization’s governance, risk management, and internal control systems. Responsible for planning, executing, and reporting on operational and regulatory compliance related audits and reviews. Ownership of the Internal Audit Workplan.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITES

• Oversees and ensures audit work is performed and documented in accordance with departmental standards.
• Owns the responsibility of Internal Audit Work Plan - this plan will include all specificities such as audit description, frequency, and audit sampling.
• Plan audits that Office of Inspector General and the Office of the Medicaid Inspector General will be reviewing as part of their workplan and ensure the Company is compliant.
• Assigns and ensures implementation of the work plan and benchmarks progress.
• Acts as primary liaison between the department’s employees, appropriate Vice Presidents and division heads.
• Works with the Compliance Officers to collaborate and own audits that are on the Compliance Work Plans.
• Ensures audits are being conducted on medical record documentation to identify under coded and up coded services; reviews report findings and sends to the physicians to provide awareness/education on accurate coding practices and compliance issues.
• Prepares timely audit reports for Executive Management, Compliance Officers and the Chief Financial Officer.
• Meet deadlines of assignments, multitask multiple demands and work with all types of individuals up to and including the Chief Financial Officer.
• Research, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Interacts with physicians, business offices, provider enrollment, managed care, informatics and other departments regarding timely and accurate billing, and documentation, policies and procedures and regulations; obtains clarification of non-specific documentation.
• Acts as a team player, collaborating and supporting colleagues and peers across the organization, while still capable of working independently when needed.
• Attends conferences, workshops and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Designs audit plans and annual work plans.
• Assesses with other departments regarding risk assessments and corrective actions.
• Cultivate relationships across departments to promote ethical practices, transparency, and continuous improvement.
• Lead, mentor, and develop internal audit staff; foster a culture of accountability, learning, and professional development.
• Promote a continuous improvement mindset and help build audit capacity across the organization.
• Performs other incidental and related duties as required and assigned.

EDUCATION AND EXPERIENCE

• High school diploma or GED required.
• Bachelor’s degree in Business Administration, Health Care Administration or related appropriate field required.
• 5 to 7 years’ minimum experience in auditing, preferably within a healthcare organization.
• 10 years' experience minimum in a supervisor position.

SKILLS AND ABILITIES

• Related experience preferred.
• Ability to direct, manage and supervise employees.
• Knowledge of CPT codes and ICD-9/10 codes.
• Knowledge of CMS Guidelines.
• Knowledge of Federal and State Compliance regulations.
• Knowledge of anatomy and medical terminology.
• Ability to conduct interviews and gather information.
• Knowledge of analytical ability.
• Ability to maintain confidentiality while multitasking.
• Excellent organizational skills and the ability to balance multiple tasks and priorities while focusing on the details.
• Strong interpersonal, verbal and written skills required.
• Ability to function well in a high-paced and at times stressful environment.
• Excellent time management skills with a proven ability to meet deadlines.
• Demonstrates strong communication, written, and typing skills.
• Proficient with Microsoft Office or related software.
• Ability to work efficiently both independently and in a team environment.
• Strong project management and team leadership capabilities.
• Exceptional organizational skills and detail oriented.

PHYSICAL REQUIREMENTS

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The work requires the following activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed primarily indoors. The employee must occasionally lift and/or move up to 25 pounds.

JOB SUMMARY

Strategic oversight of the internal audit function across the organization ensuring risk-based audit coverage and providing independent and objective assessment of the organization’s governance, risk management, and internal control systems. Responsible for planning, executing, and reporting on operational and regulatory compliance related audits and reviews. Ownership of the Internal Audit Workplan.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITES

• Oversees and ensures audit work is performed and documented in accordance with departmental standards.
• Owns the responsibility of Internal Audit Work Plan - this plan will include all specificities such as audit description, frequency, and audit sampling.
• Plan audits that Office of Inspector General and the Office of the Medicaid Inspector General will be reviewing as part of their workplan and ensure the Company is compliant.
• Assigns and ensures implementation of the work plan and benchmarks progress.
• Acts as primary liaison between the department’s employees, appropriate Vice Presidents and division heads.
• Works with the Compliance Officers to collaborate and own audits that are on the Compliance Work Plans.
• Ensures audits are being conducted on medical record documentation to identify under coded and up coded services; reviews report findings and sends to the physicians to provide awareness/education on accurate coding practices and compliance issues.
• Prepares timely audit reports for Executive Management, Compliance Officers and the Chief Financial Officer.
• Meet deadlines of assignments, multitask multiple demands and work with all types of individuals up to and including the Chief Financial Officer.
• Research, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials and billable services.
• Interacts with physicians, business offices, provider enrollment, managed care, informatics and other departments regarding timely and accurate billing, and documentation, policies and procedures and regulations; obtains clarification of non-specific documentation.
• Acts as a team player, collaborating and supporting colleagues and peers across the organization, while still capable of working independently when needed.
• Attends conferences, workshops and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Designs audit plans and annual work plans.
• Assesses with other departments regarding risk assessments and corrective actions.
• Cultivate relationships across departments to promote ethical practices, transparency, and continuous improvement.
• Lead, mentor, and develop internal audit staff; foster a culture of accountability, learning, and professional development.
• Promote a continuous improvement mindset and help build audit capacity across the organization.
• Performs other incidental and related duties as required and assigned.

EDUCATION AND EXPERIENCE

• High school diploma or GED required.
• Bachelor’s degree in Business Administration, Health Care Administration or related appropriate field required.
• 5 to 7 years’ minimum experience in auditing, preferably within a healthcare organization.
• 10 years' experience minimum in a supervisor position.

SKILLS AND ABILITIES

• Related experience preferred.
• Ability to direct, manage and supervise employees.
• Knowledge of CPT codes and ICD-9/10 codes.
• Knowledge of CMS Guidelines.
• Knowledge of Federal and State Compliance regulations.
• Knowledge of anatomy and medical terminology.
• Ability to conduct interviews and gather information.
• Knowledge of analytical ability.
• Ability to maintain confidentiality while multitasking.
• Excellent organizational skills and the ability to balance multiple tasks and priorities while focusing on the details.
• Strong interpersonal, verbal and written skills required.
• Ability to function well in a high-paced and at times stressful environment.
• Excellent time management skills with a proven ability to meet deadlines.
• Demonstrates strong communication, written, and typing skills.
• Proficient with Microsoft Office or related software.
• Ability to work efficiently both independently and in a team environment.
• Strong project management and team leadership capabilities.
• Exceptional organizational skills and detail oriented.

PHYSICAL REQUIREMENTS

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. The work requires the following activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed primarily indoors. The employee must occasionally lift and/or move up to 25 pounds.