Manager, External Audit and Revenue Integrity Job Details | Coloplast A/S

Coloplast•Minneapolis, MN

41d•$77,921 - $116,882

About The Position

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) Assist in preparing for recurring meetings with key stakeholders to ensure all affected departments are informed of the progress/challenges being observed and where improvements should be made 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. Other job duties as assigned

Requirements

Bachelor's degree or equivalent work experience
Minimum of 3 years' experience in external 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

Nice To Haves

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%

Responsibilities

Supervising, planning and directing the Audit and Revenue Integrity processes
Overseeing all internal and external audit activities
Conducting monthly revenue integrity tests with the Data Analytics Team
Managing workflow in response to CMS and OIG matters with CMLT
Communicating expectations, planning, and coaching team members
Collaborating with HR to recruit and train staff
Providing project leadership for external audits
Providing project leadership for internal audit activities
Managing a program for revenue integrity matters
Assisting in preparing for meetings with stakeholders
Leading external audit activities
Conducting periodic internal audit activities
Developing and managing an annual revenue integrity calendar
Maintaining and assisting with the implementation of policies and procedures
Overseeing the analysis, maintenance, and communication of records
Assisting with the implementation of new technologies
Observing legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA)
Ensuring staff complies with HIPAA and PHI regulations
Meeting individual, departmental, and company goals

Benefits

Comprehensive medical, dental, and vision insurance plans
Access to company sponsored wellness programs and mental health resources
Paid leave of absence for qualifying events and generous paid parental leave for both birthing and non-birthing parents
Competitive 401(k) plan with company match that vest immediately
Financial planning services
Corporate discount programs for goods and services
Generous paid time off
Flexible work hours, and flexible work arrangement options may be available
Opportunities for continuous learning and career advancement through training programs, mentorship, and tuition reimbursement
Recognition programs to celebrate achievements and contributions, including peer recognition, bonuses, awards, and special events
A supportive work environment where everyone feels valued and has a sense of belonging
Participate in team-building activities, volunteer opportunities, and company-sponsored events
Sustainability strategy that outlines our ambitions for how to run our company in a more sustainable way