Compliance Audit Manager

UT Southwestern Medical Center; Dallas (TX); On-site; USD 110,000 - 150,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

Retirement Programs (TRS)

Paid Parental Leave

Wellness programs

Tuition Reimbursement

PSLF Qualified Employer

Job summary

UT Southwestern Medical Center in Dallas seeks an experienced compliance professional to oversee auditing of reimbursement, coding, and billing practices across care sites. You will partner with the AVP/Chief Compliance Officer to identify errors and opportunities for corrective action, ensuring adherence to federal and state requirements.

The role requires 5 years of related experience, a relevant Bachelor’s degree, and professional certifications such as CHC or hospital/physician coding are

Qualifications

• Bachelor's degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area.
• 5 years progressively responsible related experience.
• Master's Degree in business or management is preferred; CHC or hospital/physician coding certifications are valued.

Responsibilities

• Manages auditing of reimbursement and compliance activities for UTSW facilities and providers.
• Responds to third-party payer audit requests and identifies significant reimbursement errors.
• Leads audits and investigations and guides remediation and action plans with leadership.

Skills

Auditing

Billing

Compliance

Healthcare administration

Education

Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area

Master's Degree in business or management

Tools

Microsoft Office (Excel)

Job description

WHY UT SOUTHWESTERN?

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you‿ll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

Works under minimal supervision reporting to the AVP of Compliance/Chief Compliance Officer, to perform assessments of risk related to health care reimbursement through third party payers, particularly Medicare, Medicaid, and other government payers, managed care payers, and the like. This role uses sources such as the OIG Work Plan, payer alerts, probe audits and internal reviews and reports from monitoring activities; methodologies such as probe auditing, statistical sampling and extrapolation; and technologies such as Microsoft Office (e.g., Excel), MDAudit, Med Analytics, electronic medical records, and other applicable tools and methodologies, to identify, quantify, and make recommendations regarding reimbursement errors and opportunities and corrective actions, for UTSW health care facilities and providers. Performs and /or manages various assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures.

Oversee coding and billing compliance activities to ensure adherence to federal and state regulations, payer requirements, and institutional policies. Manage and conduct risk-based audits of professional and facility billing, coding accuracy, documentation, and reimbursement practices. Supervise compliance staff, establish performance expectations, and ensure timely completion of audits, investigations, and advisory requests. Identify billing and coding risks, analyze trends, and recommend corrective actions to mitigate regulatory and financial exposure. Collaborate with Revenue Cycle, Clinical Departments, and operational leadership to address compliance concerns and strengthen internal controls. Oversee corrective action plans, including monitoring, validation, and reporting of remediation efforts. Provide guidance and education regarding Medicare, Medicaid, and other payer requirements, including documentation, coding, and billing standards.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

Education

• Bachelor's Degree in business or healthcare administration, regulatory compliance, consulting, project management, or related area.

Experience

• 5 years progressively responsible related experience.

Preferred

Education

• Master's Degree in business or management.

Experience

• Knowledge of clinical trial billing and/or experience in reimbursement coding, auditing, and reporting.

Licenses and Certifications

• Current certifications in hospital and physician coding Upon Hire or
• Certified Healthcare Compliance (CHC) Upon Hire

JOB DUTIES

• Manages auditing of reimbursement issues for UTSW health care providers and entities, including the claims incurred in UTSW hospitals and clinics, affiliate hospitals, ambulatory locations, and clinical trial billing.
• Assists the UTSW AVP of Compliance/Chief Compliance Officer in responding to third party payer audit requests as well as identifying and auditing significant reimbursement errors and opportunities, focusing on determination of error rates, mitigation strategies, makes recommendations for performance improvement. Provides compliance assistance to impacted providers and facilities with audit responses and activities, as appropriate.
• Works under the direction of the AVP of Compliance/Chief Compliance Officer to conduct or manage staff in performing audits and investigations. This includes developing and executing all phases of a plan of investigation; such as determining and documenting applicable payer requirements, locating, understanding, and analyzing data, information and records;