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Manager Compliance - Medical Audit Services - Gainesville

Company: UF Health Shands at the University of Florida (Gai
Location: Gainesville
Posted on: September 24, 2022

Job Description:


Job Opening Summary

Assists the Senior Director of Compliance Services and VP Compliance and Privacy in overall management of hospital compliance staff and program, and serves as a resource and point of contact for UF Health hospital compliance matters. Leads and supervises Compliance Services staff and trains employees for multi-hospital health system to include regulatory, audit, billing, coding, documentation, medical necessity and other general compliance processes and analyses, that result in appropriate reimbursement for the hospital and adherence to applicable laws, rules, guidelines and regulations. Leads compliance meetings that foster open lines of communication within the organization. Leads, directs and reviews the work of Compliance Services staff. Serves as a resource for Compliance Services staff by evaluating performance, providing support and assisting in promotion of professional development, refining methodologies, and improving departmental work products. Assures the accuracy and timely completion of compliance auditing, investigations and reviews, and the Annual Compliance Work Plan. Works to ensure all elements of an effective program are met. Experience and expertise in auditing, billing, coding, proper documentation, medical necessity evaluation and general compliance processes, including regulatory and governmental payer regulations and requirements are required. Experience and expertise in report writing, findings analysis, and ability to enter and manipulate database applications and other compliance systems. Must be familiar with a variety of the fields concepts, practices, and procedures. Relies on experience and judgement to plan and accomplish goals. Performs a variety of compliance tasks. A degree of creativity and latitude is expected.

Job Opening Qualifications

Minimum Education and Experience Requirements:
Minimum five years experience in compliance, audit, legal or equivalent field. Bachelors or higher degree and CHC (Certified in Healthcare Compliance) designation is required, or obtained within six months of hire. RN, LPN, or other clinical degrees and licenses would be valuable. Additional Compliance-related certifications are preferred (e.g., CPC (Certified Professional Coder), RHIA (Registered Health Information Administrator), CPMA (Certified Professional Medical Auditor), CCS (Certified Coding Specialist), or Certified Healthcare Internal Audit Professional (CHIAP)). Compliance, clinical, coding, auditing, legal or related work experience is required. Experience responding to or performing Medicare, Medicaid and other governmental or regulatory audits, investigations or inquiries is preferred. Knowledge of and/or experience in Medicare, Medicaid and other regulations that impact hospitals, hospital charging, documentation, coding and billing procedures, medical records, medical necessity, or knowledge of audit techniques required. Requires excellent verbal and written communication skills. Ability to problem solve and perform research is essential. Must be organized, versatile, and able to work independently.

Motor Vehicle Operator Designation:
Employees in this position:

Will operate vehicles for an assigned business purpose as a non-frequent driver

NOTE: A frequent driver is defined as one who uses his/her personal or Shands automobile
a) at least once daily, b) at least five individual trips per week or c) drives, on average, over 150 miles per week in the performance of his/her job.

Licensure/Certification/Registration:
CHC certification required.

Keywords: UF Health Shands at the University of Florida (Gai, Gainesville , Manager Compliance - Medical Audit Services - Gainesville, Healthcare , Gainesville, Florida

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