Manager, Audit and Revenue Integrity

Manager, Audit And Revenue Integrity

Responsible for supervising, planning and directing the Audit and Revenue Integrity processes. Will oversee all internal and external audit activities and will conduct in conjunction with the Data Analytics Team to perform monthly revenue integrity tests that ensures payer compliance. Will work with Comfort Medical Leadership Team (CMLT) to manage the workflow process in response to Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) matters.

Major Areas of Accountability

Leadership and Team Management - Accomplish results by communicating expectations, planning and properly coaching and mentoring team members. Collaborate with HR to recruit required staff positions as well as train and orient the corresponding hires to their job function. Provide project leadership to ensure all external audits are conducted within the allotted timeframe(s) and that information provided in response to such audit is of the highest quality and is complete. Provide project leadership that ensures all internal audit activities are conducted in such a fashion as to identify areas of potential weakness and will communicate such findings to CMLT. Will manage a program for revenue integrity matters that ensures a cross-sectional analysis of all payers is performed that promotes compliance with contract(s).

Job Duties

Will lead all activities and will work with leadership and N / A Compliance Team for communication purposes related to any external audit activities, including CMS CERT, SMRC, RAC, TPE, UPIC, ZPIC, or other third-party audit, as may required. Working in conjunction with the N / A Compliance Team to conduct periodic, internal audit activities and will provide detailed reporting on any deficiencies or achievements as indicated. Will develop and manage an annual revenue integrity calendar to ensure that all payers payment activities are monitored on at least a biennial basis, if not more frequently. Maintain and assist with the implementation of the policies and procedures, including Standard Operating Procedures required by Comfort Medical as a covered entity. Oversee the analysis, maintenance, and communication of records required by law or local governing bodies, or other departments in the organization. Assist with the implementation of new technologies, tools and system applications, as may be applicable, that have the ability to increase production and streamline processes or procedures. Observe legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA) and ensure that staff complies with HIPAA and PHI regulations. Meet individual, departmental, and company goals.

Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.

Basic Qualifications

Bachelor's degree or equivalent work experience. Minimum of 3 years' experience in audit, compliance, or similar role in a DMEPOS or infusion pharmacy environment. Excellent written and verbal communication skills. Ability to work successfully as an individual and team contributor. Strong contract, financial, and business acumen and excellent strategic business understanding. Ability to clearly articulate in both oral and written format. Working knowledge of Brightree or other similar DME business management software. Ability to attend off-site meetings as required.

Preferred Qualifications

Knowledge of Medicare, Medicaid, commercial insurers, related regulations, billing codes, specifically diagnostic and procedural terminology, ICD and CPT / HCPCS coding systems, licensing and compliance rules, as well as audits. Able to effectively communicate with all levels and areas of the organization, leading multiple projects and manage deadlines; proficient in the English language. Willingness and ability to travel, including overnight - up to 20%.