Compliance Audit Manager

What Ethics & Compliance contributes to Cardinal Health

Ethics & Compliance promotes a culture that encourages ethical conduct and a commitment to compliance. This function implements strategies and processes to ensure adherence to policies, educates and trains employees across the organization, and conducts investigations to resolve ethics and compliance issues.

Compliance Audit Manager

Reporting to the Compliance Director, this position supervises and manages compliance audits to determine organizational integrity of billing for professional (physician) services and / or hospital (technical) services. This position will also support the Director with transactional audit diligence and integration planning, as well as the development and completion of the annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff.

Responsibilities

Plans professional compliance department audits to determine accuracy and adequacy of documentation and coding related to physician or hospital (inpatient and outpatient) billing and / or medical necessity reviews.

Prepares written reports of audit findings and recommendations; presents to appropriate stakeholders; evaluates the adequacy of management corrective action to improve deficiencies; maintains audit records.

Conducts risk assessments to define audit priorities based on previous audit findings, management priorities, coding utilization patterns, national normative data, CMS and CCI initiatives, OIG work plans and advisories as well as healthcare industry best-practices.

Develops and implements compliance training and education to ensure compliance with federal and state regulations and laws, CMS and other third-party payer billing rules and internal documentation, coding and billing policies and procedures.

Provides feedback and training for physicians and staff regarding coding insufficiencies.

Serves as institutional subject matter expert and authoritative resource regarding federal, state and payer documentation, billing and coding rules and regulations, maintaining awareness of governmental regulations, protocols and third-party requirements.

Serves as liaison with 3rd party auditors conducting audits as well as manages in-house auditing staff.

Supports the overall workplan of the Compliance Department.

Qualifications

Bachelor's degree in Health Information Management, Business or related field preferred.

6+ years of experience in physician and / or hospital coding and auditing, medical necessity reviews, or related work; cancer and urology service line experience preferred; ASTRO and ACR-guideline knowledge a plus.

AAPC, AHIMA or HCCA Coding certification and or Auditing / Compliance certification (CPC, CCS, CCS-P, COC, CPMA, CHC) preferred.

Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure.

Understands institutional risks and shows appropriate judgment, using a risk-based approach in planning and executing audit plans.

Expert-level knowledge and application of Medicare / Medicaid documentation and coding rules and guidelines; ICD / CPT / HCPCS / DRG / APC documentation coding rules; medical terminology; E / M rules; healthcare compliance audit methodology, principles and techniques; ability to interpret medical record progress notes, handwritten and electronic chart entries, provider orders and other related documentation during audit reviews.

Ability to communicate complex and potentially sensitive issues to all levels of management, physicians, and others; strong presentation and communication skills (MS Word, Excel, PowerPoint, and Outlook).

What is expected of you and others at this level

Manages department operations and supervises professional employees, front line supervisors and / or business support staff

Applies advanced knowledge and understanding of concepts, principles, and technical capabilities to manage a wide variety of projects

Participates in the development of policies and procedures to achieve specific goals

Recommends new practices, processes, metrics, or models for a successful auditing program

Possesses strong attention to detail

Ability to effectively prioritize and execute tasks in a fast-paced, dynamic environment

Independently determines method for completion of new projects

Receives guidance on overall project objectives

Excellent time management, personal integrity and ability to maintain confidentiality.

Anticipated salary range : $105,100 - $140,100

Bonus eligible : Yes

Benefits : Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

Medical, dental and vision coverage

Paid time off plan

Health savings account (HSA)

401k savings plan

Access to wages before pay day with myFlexPay

Flexible spending accounts (FSAs)

Short- and long-term disability coverage

Work-Life resources

Paid parental leave

Healthy lifestyle programs

Application window anticipated to close : 01 / 07 / 2025

• if interested in opportunity, please submit application as soon as possible.

The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate's geographical location, relevant education, experience and skills and an evaluation of internal pay equity.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity / expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

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