Bon Secours Mercy Health · 1 day ago
Compliance Audit Manager
Plain City, OH
Full-time
Onsite
Mid, Senior Level
5+ years expBon Secours Mercy Health is dedicated to improving health care quality and safety. They are seeking a Compliance Audit Manager to manage revenue cycle compliance initiatives, identify risks, and oversee auditing protocols related to healthcare services.
Health Care
Responsibilities
Works collaboratively with the Director, Compliance on creating auditing and monitoring protocols that align with Bon Secours Mercy Health’s overall compliance audit and compliance responsibilities relative to acute and physician revenue cycle services performed for Bon Secours Mercy Health
Oversees acute and provider compliance audits including work plan items, management requests, Merger and Acquisition due diligence coding audits and assessments, and responses to governmental audits and inquiries
Assesses and makes recommendations to improve internal controls and policies and procedures for both acute and provider Revenue Cycle operations including the development of SOPs
Develops acute and provider compliance monitoring and audit protocols specific to revenue cycle compliance risk areas highlighted by the Office of Inspector General (OIG), Medicare, State Medicaid, State Insurance Fraud, Managed Care or Governmental Value-Based payment programs or other enforcement agencies on behalf of Bon Secours Mercy Health
Coordinates periodic review and analysis of Bon Secours Mercy Health provider claims denial reports, operational assessment reports, internal quality control reviews, internal and external third-party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues
Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect and trend potential claims and billing compliance issues
Assists in the development of corrective action plans (CAP), oversight tools and technical edit enhancements to support acute and physician revenue cycle services operational efforts. Assists in tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation
Maintains awareness of regulations and current industry changes that may impact healthcare physician revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
Ensures that the Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status
Develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities
Qualification
Required
Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) or Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC)
Bachelor's Degree in Healthcare Auditing, Physician Revenue Cycle, or related field
5 years' of experience within healthcare revenue cycle operations and healthcare auditing either from a consulting perspective or as an associate or manager
Preferred
Certificate of Healthcare Compliance (CHC)
EPIC Electronic Medical Records System
Benefits
Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
Tuition assistance, professional development and continuing education support
Company
Bon Secours Mercy Health
Bon Secours Mercy Health is a network of hospitals that serves as a catholic healthcare ministry.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Chris Hilton
CFO, Hospital & Integrated Operations
Veronica Scott-Fulton
System Chief Nurse Executive
Recent News
2025-11-14
EIN Presswire
2025-10-27
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