Manager, Compliance Review

UPMC•Pittsburgh, PA

4d•Remote

About The Position

UPMC Corporate Legal is hiring a Manager, Compliance Review. Under the direction of the Director of Corporate Compliance, the manager assists with developing compliance programs and related educational and training materials throughout UPMC. The role supports compliance activities, including HIPAA for the health system, and works collaboratively with UPMC Compliance and Privacy Officers, Patient Business Services, Corporate Legal, and Internal Audit as needed. The manager helps plan compliance activities by setting measurable goals and establishing monitoring and reporting processes for ongoing compliance and ethics work under the direction of the Chief Compliance Officer. This highly visible role interacts with UPMC business units at all organizational levels. The position leads and oversees the health system’s Evaluation and Management (E/M) compliance program, including auditing and monitoring coding, documentation, billing, and reimbursement practices.

Requirements

Professional-level degree, or equivalent work experience and a professional certification; a BS degree is preferred.
At least five years of work experience in management and compliance-related activities such as Regulatory Review, Medical Records, Registration, Billing, Investigation, and Reporting.
Current professional coding certification, such as CPC, CCS-P, or equivalent.
Knowledge of Microsoft Office applications.
Well-developed analytical, problem-solving, and interpersonal skills.
Act 34 clearance.

Nice To Haves

Experience within revenue cycle.
Experience in a hospital.
BS degree.

Responsibilities

Lead and oversee the health system’s Evaluation and Management (E/M) compliance program, including auditing and monitoring E/M coding, documentation, billing, and reimbursement practices.
Monitor E/M coding and billing trends and regulatory guidance to identify potential compliance risks, recommend corrective actions, and support consistent application of E/M requirements across the health system.
Serve as a subject matter expert for E/M compliance, partnering with Compliance, Coding, Revenue Cycle, clinical departments, and other stakeholders to provide guidance, education, and support related to E/M documentation and billing requirements.
Communicate and support the UPMC mission and values to employees at all levels of the health system and Insurance Services Division.
Assist with analysis, problem solving, and investigations.
Lead, plan, develop, and conduct education and training activities related to compliance and ethics topics.
Coordinate and facilitate activities to achieve compliance with government-established deadlines.
Develop presentations and educational materials for individuals at all levels of the health system and Insurance Services Divisions, and provide education and compliance regulatory updates.
Establish monitoring mechanisms and conduct routine audits of the compliance and ethics program.
Assist with establishing policies and procedures in support of compliance and ethics activities.