Hybrid SIU Medical Records Audit Lead

Inland Empire Health Plan; Rancho Cucamonga (CA); Ibrido; USD 119.000 - 157.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive salary

On-site fitness center

Medical Insurance with Dental and Vis

Life, short-term, and long-term dis

CalPERS retirement

457(b) plan with employer match

Descrizione del lavoro

Inland Empire Health Plan (IEHP) seeks a senior leader to head the SIU Medical Record Audit function, directing prepayment and post-payment audits and ensuring defensible, compliant determinations. You will shape QA programs, metrics, and reporting while driving cost avoidance and financial recovery outcomes.

A strong regulatory background and leadership skills are essential. The role requires clinical licensure awareness and collaboration with regulators, providers, and IEHP leadership, in a

Competenze

• Bachelor’s degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, Health Information Management, or related field required.
• Advanced degree strengthens program leadership and analytics capabilities.
• Certifications in coding, auditing or fraud investigation are highly preferred.
• Active clinical licensure (RN or equivalent) is a plus.
• Experience with Medi-Cal/Medicare regulatory framework is essential.

Mansioni

• Provide strategic and operational leadership for SIU’s medical record audit program.
• Direct prepayment and post-payment medical record audits and determine compliance findings.
• Ensure audit accuracy, defensibility, and regulatory readiness for reviews and appeals.
• Develop QA, dashboards, and performance metrics to monitor efficiency and impact.
• Lead staff hiring, training, and performance management.
• Collaborate with regulators, law enforcement, and leadership to remediate findings.

Conoscenze

Medical record audits

Coding audit

Regulatory compliance

Data analytics

Leadership

Project management

Communication

Excel

Word

PowerPoint

Formazione

Bachelor’s degree in Medical Billing/Medical Coding/Nursing/Healthcare Administration/Health Information Management (or related)

Advanced degree (MBA, MHA, MPH, MSN, MS‑HIM)

Certified Professional Coder (CPC)

Certified Professional Medical Auditor (CPMA)

Certified Coding Specialist (CCS)

Certified Fraud Examiner (CFE) / AHFI / CHC / CPCO

Active RN or other clinical licensure

Strumenti

Excel

Word

PowerPoint

Antifraud/data platforms

Descrizione del lavoro

Inland Empire Health Plan (IEHP) seeks a senior leader to head the SIU Medical Record Audit function, directing prepayment and post-payment audits and ensuring defensible, compliant determinations. You will shape QA programs, metrics, and reporting while driving cost avoidance and financial recovery outcomes.

A strong regulatory background and leadership skills are essential. The role requires clinical licensure awareness and collaboration with regulators, providers, and IEHP leadership, in a