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Audit Manager

Job ID: 4668980
Updated: November 5, 2018
Geographic Location: 
Department: Administration
Full/Part Time: Full-Time
Shift: Days
Standard Hours: 40
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Job Summary

Under the direct supervision of the Director, Internal Audit, this position contributes to the Mercy Health and Ensemble mission and vision by managing the internal audit staff related to Ensemble revenue cycle-third party billing.  Ensemble RMC LLC is a owned subsidiary of Mercy Health and provides a wide-range of revenue cycle services to Mercy Health and non-Mercy Health clients.  This position oversees and provides revenue cycle related internal audit activities relative to Mercy Health and Ensemble operations conducted at local (Ohio) and remote locations (North Carolina) and supports internal auditing requested by non-Mercy clients as part of contractual obligations.

Job Responsibilities:

  • Oversees auditing staff that conduct internal audits and/or information technology audits of Mercy Health and non-Mercy client internal controls and policies and procedures for Revenue Cycle operations
  • Develops internal audit monitors and audit protocols specific to revenue cycle risk areas highlighted by the OIG Program Guidelines for Third Party Billing Companies, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and/or other enforcement agencies on behalf of Mercy Health and non-Mercy clients
  • Works collaboratively with the Director, Audit on creating internal auditing protocols which align with Mercy Health’s overall internal audit and compliance responsibilities relative to Ensemble’s revenue cycle-third party billing services performed for Mercy Health as well as non-Mercy clients
  • Coordinates periodic review and analysis of Mercy Health and non-Mercy client’ claims denial reports, operational assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues
  • Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas
  • Assists in the development of corrective action plans (CAP), oversight tools and technical edit enhancements to support revenue cycle services operational efforts. Assists in tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation
  • Develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance.  Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities

Qualifications - Minimum

  • Three to five years of in-depth experience within healthcare revenue cycle operations, healthcare internal auditing and/or information technology auditing either from a consulting perspective or as an employee/manager
  • Demonstrated working knowledge of healthcare revenue cycle operations, Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies, as well as extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations and compliance guidances required
  • CPA or CIA preferred
  • EPIC experience preferred
  • 4 Year/Bachelors Degree in Healthcare Auditing, Healthcare or HIM required; Combination of post-secondary education and experience will be considered in lieu of degree

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

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