Compliance Audit Manager

Compliance Audit Manager

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. 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 :

What is expected of you and others at this level :

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.

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.