Compliance Audit Manager

UT Southwestern Medical Center • Dallas, TX

2d

About The Position

The Compliance Audit Manager works under minimal supervision and reports to the AVP of Compliance/Chief Compliance Officer. The role assesses risks related to health care reimbursement through third-party payers, particularly Medicare, Medicaid, other government payers, and managed care payers. It uses payer guidance and alerts, the OIG Work Plan, probe audits, internal reviews, monitoring reports, statistical sampling and extrapolation, and applicable technologies to identify and quantify reimbursement errors and opportunities and recommend corrective actions for UT Southwestern health care facilities and providers.

The position oversees coding and billing compliance activities and conducts or manages risk-based audits of professional and facility billing, coding accuracy, documentation, and reimbursement practices. It supervises compliance staff, establishes performance expectations, and ensures timely completion of audits, investigations, and advisory requests. The manager works with Revenue Cycle, clinical departments, operational leadership, providers, facilities, legal counsel, auditors, and other partners to address compliance concerns, strengthen internal controls, and support corrective action and education. The role also prepares analytical reports and metrics for leadership and compliance committees.

The position requires a bachelor's degree in a relevant business, health care, regulatory compliance, consulting, project management, or related field, and five years of progressively responsible related experience. A master's degree and knowledge of clinical trial billing or reimbursement coding, auditing, and reporting are preferred. Current hospital and physician coding certifications or Certified Healthcare Compliance (CHC) certification are required upon hire. The position is based in an office setting and includes talking as a physical requirement. Salary is commensurate with education, skills, and relevant experience.

Requirements

• Bachelor's degree in business or health care administration, regulatory compliance, consulting, project management, or a related area.
• Five years of progressively responsible related experience.
• Current certifications in hospital and physician coding upon hire, or Certified Healthcare Compliance (CHC) certification upon hire.
• Ability to evaluate data and determine compliance with rules and regulations.
• Ability to perform accurate statistical analysis of claims data using recognized tools such as RAT-STATS and other statistical tools, including extrapolations and calculations of reimbursement errors and opportunities.
• Integrity, discretion, confidentiality, and reliability, including the ability to maintain confidentiality when working under attorney-client privilege.
• Effective written and verbal communication skills and excellent interview skills.
• Skill in spreadsheet applications, word processing, technology solutions such as MD Audit, and database computer applications.
• Ability to communicate with internal and external personnel and organizations to obtain or provide information and explain facts, policies, and procedures to resolve recurring, non-routine problems.
• Ability to code and interpret claims to third-party payers and supporting documentation, remittance advices, and reimbursement received.
• Ability to work effectively with providers, facilities, and their administrative staffs.
• Working knowledge of payer requirements for claims adjudication and payment.

Nice To Haves

• Master's degree in business or management.
• Knowledge of clinical trial billing and/or experience in reimbursement coding, auditing, and reporting.

Responsibilities

• Manage audits of reimbursement issues for UT Southwestern providers and entities, including claims from hospitals, clinics, affiliate hospitals, ambulatory locations, and clinical trial billing.
• Assist the AVP of Compliance/Chief Compliance Officer with third-party payer audit requests and with identifying and auditing significant reimbursement errors and opportunities.
• Determine error rates, develop mitigation strategies, and recommend performance improvements; assist impacted providers and facilities with audit responses and activities.
• Conduct or manage staff performing audits and investigations, including planning investigations, identifying and analyzing requirements and records, auditing data, and drafting findings and conclusions.
• Recommend and document corrective actions, and consult with affected providers or facilities to support agreement and follow-through.
• Recommend education and training topics to improve performance and reduce reimbursement errors.
• Track and disseminate relevant payer information about applicable billing and compliance requirements.
• Help develop metrics for providers, facilities, and leadership concerning performance and compliance with reimbursement rules, regulations, and contracts.
• Ensure timely and consistent interpretation, follow-through, and resolution of reported compliance concerns.
• Work with internal or external legal counsel, auditors, or consultants on health care reimbursement projects when requested.
• Coordinate with Office of Compliance directors and staff to ensure auditing and monitoring activities are evidence-based, supported by metrics, and meet compliance program effectiveness requirements.
• Oversee designated compliance analyst staff, establish performance expectations, and ensure timely completion of work.
• Identify trends and recommend improvements to culture, transparency, trust, and compliance plan goals.
• Design and prepare statistical and analytical reports for UT System, executive, and campus compliance committees.
• Perform other duties as assigned.

Benefits

• PPO medical plan available on day one at no cost for full-time employee-only coverage.
• Preventive healthcare coverage at 100% with no copay.
• Paid Time Off available on day one.
• Retirement programs through the Teacher Retirement System of Texas (TRS).
• Paid Parental Leave Benefit.
• Wellness programs.
• Tuition reimbursement.
• Public Service Loan Forgiveness (PSLF) qualified employer.
• Competitive benefits package including healthcare, PTO, paid holidays, on-site childcare, and merit increases.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager