Job Description

POSITION SUMMARY:

  • The Manager-Revenue Integrity Audits will manage a team of Revenue Integrity Auditors/Educators, principally clinicians and certified coders, as well as external audit/education resources, that perform hospital, physician and allied services billing compliance auditing and monitoring activities for Steward Health Care System (Steward). These revenue integrity audits will focus on evaluating compliance with Steward policies as well as compliance with applicable Medicare, Medicaid and other third party guidelines in effect as of the applicable date of service, including identification of lost revenue opportunities and overpayments that need to be refunded to due documentation, coding or billing issues.
  • This position reports to the Vice President, Compliance & Privacy Operations for Steward. The Manager-Revenue Integrity Audits needs to be a person of high integrity, and any other duties assigned should not be in conflict with Steward’s compliance program goals and objectives. This position will be based in the OCCP’s Central Office in Westwood, MA and will require travel to other Steward locations.
  • This position is responsible for driving compliance program “operational excellence” (i.e., standardization, scalability, effectiveness and efficiency) related to hospital auditing and monitoring system-wide. Furthermore, this position will be responsible for adapting the capability of the team of Revenue Integrity Auditors to meet an evolving landscape of regulatory compliance requirements (e.g., ICD-10, etc.).

REQUIRED KNOWLEDGE & SKILLS:

  • Knowledge and experience with hospital related health care laws and regulations (e.g., Anti-Kickback Statute, Stark Law, etc.), and hospital inpatient and outpatient coding and billing compliance required.
  • Familiarity with federal and state privacy laws and regulations required.
  • Familiarity with operational, financial, and information technology security procedures and regulations a must.
  • Strong oral/written communication and presentation skills a must.
  • Strong leadership, organizational, interpersonal and analytical skills and the ability to function effectively in a fast-paced environment.
  • Ability to prioritize and plan work independently.
  • Ability to interact with employees at all levels.
  • Effectively work with and coordinate the activities of external consultants and legal counsel as assigned.
  • Ability to anticipate potential issues and proactively respond.
  • Good judgment and problem solving skills.
  • Team player.
  • Ability to maintain confidentiality.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

  1. Education: A bachelor’s degree required..
  2. Experience: A minimum of 5 years experience in a health care environment to include demonstrated management and leadership in hospital billing compliance/auditing.
  3. Certification/Licensure: Certified Coding Specialist—Hospital-Based (CCS-H) or Certified Professional Coder (CPC) required. Additional specialty coding certifications (e.g., Evaluation and Management, Emergency Department, etc.) desired. Certification in Healthcare Compliance (CHC) certification preferred. Software/Hardware: Microsoft Outlook, Word, Excel, Internet Explorer and PowerPoint Skills Required. Microsoft Access Skills preferred. Ability to effectively navigate electronic health records and hospital billing systems is required. Ability to research applicable Medicare, Medicaid and other compliance requirements is required.
  4. Other: Travel Requirements:
  • The ability to travel regionally and nationally
  • Must have a valid driver's license, provide own transportation, and be able to travel to Steward locations using a variety of modes of transportation

Application Instructions

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