Manager Compliance Audit

UT Southwestern Medical Center • Dallas, TX

4d

About The Position

The Manager Compliance Audit will serve as the primary point of contact for external audits (RAC, OIG, MAC, and other federal/state agencies), ensuring timely and accurate submission of requested records. Oversee tracking, documentation, and reconciliation of all audit requests and outcomes. Coordinate and manage the appeals and denials process, ensuring deadlines are met and documentation is complete. Identify high-risk areas and oversee risk-based internal audits, including focused reviews and quarterly audit activities conducted by Compliance Analysts. Develop and monitor corrective action plans (CAPs) to address billing, coding, and documentation deficiencies. Analyze audit and denial trends to identify systemic risks and inform compliance strategy. Collaborate with coding, revenue cycle, and clinical teams to ensure alignment and provide targeted education based on findings.
Works under minimal supervision reporting to the Director Health System Compliance, to perform assessments of risk related to health care reimbursement through third party payers, particularly Medicare, Medicaid, and other government payers, managed care payers, and the like. This role uses sources such as the OIG Work Plan, payer alerts, probe audits and internal reviews and reports from monitoring activities; methodologies such as probe auditing, statistical sampling and extrapolation; and technologies such as Microsoft Office (e.g., Excel), MDAudit, Med Analytics, electronic medical records, and other applicable tools and methodologies, to identify, quantify, and make recommendations regarding reimbursement errors and opportunities and corrective actions, for UTSW health care facilities and providers. Performs and /or manages various assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures

Requirements

• Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area.
• 5 years progressively responsible related experience.
• Current certifications in hospital and physician coding Upon Hire or
• Certified Healthcare Compliance (CHC) Upon Hire

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

• Manages auditing of reimbursement issues for UTSW health care providers and entities, including the claims incurred in UTSW hospitals and clinics, affiliate hospitals, ambulatory locations, and clinical trial billing.
• Assists the UTSW AVP of Compliance/Chief Compliance Officer in responding to third party payer audit requests as well as identifying and auditing significant reimbursement errors and opportunities, focusing on determination of error rates, mitigation strategies, makes recommendations for performance improvement. Provides compliance assistance to impacted providers and facilities with audit responses and activities, as appropriate.
• Works under the direction of the AVP of Compliance/Chief Compliance Officer to conduct or manage staff in performing audits and investigations. This includes developing and executing all phases of a plan of investigation; such as determining and documenting applicable payer requirements, locating, understanding, and analyzing data, information and records; auditing data; and drafting findings and conclusions.
• Recommends and documents appropriate corrective action or actions responsive to findings and conclusions. Consults with impacted provider or facility to assure concurrence and follow through.
• Recommends education and training topics to the Office of Compliance to improve performance and reduce reimbursement errors.
• Assists the AVP of Compliance/Chief Compliance Officer with tracking and disseminating relevant payer information regarding current/applicable billing and compliance requirements.
• Assists the AVP of Compliance/Chief Compliance Officer with development of meaningful metrics for constituents such as providers, facilities and leadership, regarding performance and compliance with reimbursement rules and regulations, contracts, etc.
• Ensures timely and consistent interpretation, follow through, and resolution of reported compliance concerns.
• As applicable and when requested, works with external or internal legal counsel, external auditors or consultants, to assure successful completion of projects related to health care reimbursement.
• Coordinates and collaborates with the Directors within the Office of Compliance (and their staffs) to assure auditing/monitoring activities are evidence-based, supported by metrics, and meet the requirements of compliance program effectiveness.
• Oversees designated compliance analyst staff.
• Identifies trends and makes recommendations to improve culture, increase transparency, build trust and/or achieve compliance plan goals.
• Designs and prepares statistical and analytical reports for UT System, Executive and other campus Compliance Committees, and UT System, as appropriate.
• Performs other duties as assigned

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 coverage for preventive healthcare-no copay
• Paid Time Off, available 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

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees