Director Physician Services Audit And Compliance

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Director Physician Services, Audit and Compliance
Duties: Manage and deliver internal audit and compliance activities to assure they are conducted according to professional standards with the goal of maximizing value for the company. Current activities include physician and advanced practice professionals billing and coding audits, internal audit engagements throughout the system, data analytics, process improvement projects, special investigations and special projects as requested by management. Compliance functions include all seven elements of an effective compliance program. Direct multiple projects concurrently including refining the scope based on risk assessment, executing fieldwork, workpaper review, preparing reports and monitoring of followup. Present audit conclusions and value-added recommendations to Senior management that reflect a strong understanding of company objectives and capabilities, control requirements, and industry best practices to facilitate change in a constructive and collaborative manner. Assist the departmental senior leadership team in developing risk assessments and the annual compliance and audit plans. Oversee the execution and review of work of auditors and analysts to assure work is of high quality, timely and in accordance with overall department objectives and guidelines. This position will identify trends with billing and coding a well as audit and consulting best practices that can be implemented in the department in order to more effectively provide value to our customers. Supervise, mentor, and provide performance management for staff working on assigned engagements. Participate in the interview process of potential auditors and analysts and provide strong leadership in recruiting, building and developing talent at various levels. Lead the physician services audit and monitoring function over billing and coding for all care providers. Identify a risk-based approach to the audits that include consideration of the OIG Workplan, NCD/LCDs, and billing guidelines that are new, changed, or frequently identified as complex or having inappropriate billing issues. Utilize data analytics to qualify the population and target samples that best protect UPMC as well as evaluate the accuracy of clinical documentation and billing. Develop and manage compliance programs to achieve compliance with regulations, rules and standards or conduct. Establish policies and procedures to support compliance activities. Plan, develop and conduct communications and educational and training sessions related to specific compliance topics. Establish monitoring mechanisms and conduct routine audits and compliance programs. Oversee coordination and facilitation of the work of compliance officers/liaisons across assigned areas as well as individuals and groups throughout these UPMC departments/divisions, across a wide range of compliance topics. Departmental Goals and Time Management: Contributes to defining and meeting departmental goals. Successfully manages many competing demands and is able to deliver projects on time and within budgeted hours. Assists the department in making sure that staff analysts and auditors are productive and have adequate work load. Meets departmental goals for productivity and monitors deadlines for reports, follow-up and Board reporting. Proactive in identifying staff downtime and assists in helping staff to stay productive. Identifies opportunities for process improvements within the department and efficient resolutions for them.

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