Healthcare Compliance Audits & Investigations Manager

DHR Health; Edinburg (TX); Presencial; USD 85 000 - 140 000; Tempo integral

Resumo da oferta

DHR Health in Edinburg, TX is seeking a Compliance Audits and Investigation Manager to oversee internal coding audit programs across the system and affiliates. The role reports to the Chief Compliance & Privacy Officer and requires strong communication with leadership.

Responsibilities include leading investigations, developing audit plans, and ensuring compliance with Medicare/Medicaid rules, privacy regulations, and organizational policies. A CHC or CIA and a BS/BA are preferred.

Qualificações

• Certification in Compliance (eg. CHC) is preferred.
• Certified Internal Auditor certification preferred.
• Bachelor’s Degree (BS/BA) preferred.
• Good written and verbal communication skills required.
• Ability to read, write and speak English.
• Ability to communicate clearly and concisely with all levels of management.

Responsabilidades

• Promote the facility's mission, vision, and values by effectively communicating and demonstrating them in daily operations.
• Develop and implement detailed audit and monitoring programs of varying complexity and scope to assess compliance with organizational policies, regulatory requirements, and industry standards.
• Lead and manage compliance investigations, including allegations of regulatory noncompliance, HIPAA privacy concerns, documentation issues, billing concerns, and other compliance-related matters.
• Perform fact-finding activities, including document reviews, interviews, data analysis, and coordination with internal stakeholders to determine findings and recommend corrective actions.
• Oversee the intake, tracking, investigation, resolution, and documentation of compliance and privacy concerns to ensure timely and appropriate disposition.
• Participate in the administration and ongoing effectiveness of the Compliance and HIPAA Privacy Programs, including monitoring compliance with applicable laws, regulations, and organizational policies.
• Prepare comprehensive written reports summarizing audit and investigation findings, identifies root causes, and works collaboratively with leadership to implement corrective action plans and process improvements.
• Research applicable regulatory, documentation, coding, reimbursement, privacy, and compliance requirements and incorporate findings into audit plans, investigations, and monitoring activities.
• Coordinate audit planning, compliance reviews, investigations, and resolution of findings with the Chief Compliance & Privacy Officer and other organizational leaders.
• Review, develop, recommend, and implement policies, procedures, systems, and controls to strengthen compliance, privacy, and revenue integrity processes.
• Review documents and information relevant to compliance activities including, but not limited to, patient records, billing records, contracts, marketing materials, vendor arrangements, physician relationships, and other business records.

Conhecimentos

Compliance auditing

Internal auditing

Regulatory knowledge

Communication skills

English proficiency

Formação académica

Bachelor's degree (BS/BA) preferred

Certified Internal Auditor preferred

Compliance certification (CHC) preferred

Descrição da oferta de emprego

DHR Health in Edinburg, TX is seeking a Compliance Audits and Investigation Manager to oversee internal coding audit programs across the system and affiliates. The role reports to the Chief Compliance & Privacy Officer and requires strong communication with leadership.

Responsibilities include leading investigations, developing audit plans, and ensuring compliance with Medicare/Medicaid rules, privacy regulations, and organizational policies. A CHC or CIA and a BS/BA are preferred.