Position Summary :
The Senior Compliance Audit Manager will report to the VP of Compliance and play an integral role in supporting the compliance program activities of Sonic Healthcare USA, specifically within the WSW Division. This role will involve auditing and monitoring, educational initiatives, risk assessment, and the development of policies and procedures. A focus on clinical and billing compliance, as well as data analytics, will be critical for success. The ideal candidate will also help facilitate compliance training company-wide and assist in compliance complaint investigations.
Principal Responsibilities :
Conduct annual compliance department risk assessments to help formulate the department's work plan.
Create data tracking systems for detecting and monitoring compliance risks, and propose corrective measures when necessary.Compile and analyze both internal and external audit data.Manage audits concerning federal and state exclusion sanctions lists.Oversee compliance and HIPAA training for new hires and annually.Review billing cycle functions to ensure compliance, including ABNs, standing orders, charge master, and denials.Communicate audit findings and recommend actionable solutions.Establish and refine auditing systems to ensure compliance with WSW Division policies.Billing ComplianceImplement regular audit mechanisms within the XiFin environment.
Generate necessary data reports to support compliance inquiries.Regularly review updates on CCI edits, MUEs, and LCD / NCDs relevant to WSW billing.Manage BBB billing complaints effectively.Act as a compliance liaison between XiFin and the WSW division.Develop and maintain billing policies and procedures for the WSW division.Compliance InspectionsUtilize established inspection tools to identify areas of non-compliances and generate reports.
Guide corrective actions and track their implementation and success rates.Engage in employee training for Compliance and HIPAA.Other ResponsibilitiesPromote and embody Sonic Healthcare’s values, Compliance Plan, and standards of conduct.
Provide regulatory guidance affecting laboratories to staff members.Stay up to date with relevant laws and regulations.Engage in continuous education regarding compliance updates from various governing bodies.Participate in compliance discussions and training sessions across various departments.Education :
Bachelor's Degree in relevant fields such as Chemistry, Biology, Medical Technology, Healthcare Compliance, Health Sciences, or Healthcare Administration preferred.Certification in Healthcare Compliance and / or Medical Coding and Billing highly desirable.Experience :
At least three years of medical billing experience, with a strong emphasis on laboratory billing.Minimum three years of corporate compliance experience in the healthcare sector.Experience in laboratory training and / or a medical laboratory environment for at least three years.Familiarity with XiFin, FIN, and Misys software systems.Skills :
Strong knowledge of healthcare fraud, waste, and abuse regulations as they pertain to laboratory compliance.Expertise in Medicare billing regulations and compliance guidelines.Proficient understanding of laboratory billing processes including Managed Care and both private and government payors.Capability in scope and root cause analysis as well as corrective actions.Ability to conduct audits proactively to identify issues and mitigate risks.Highly developed analytical skills for both qualitative and quantitative data.Project management skills with an ability to meet tight deadlines.Exceptional attention to detail and accuracy.Excellent verbal and written communication skills.Proven ability to exercise initiative, discretion, and judgment.Strong aptitude for providing sound advice to management and staff on governance and compliance matters.Travel : Expected travel is one week per month.
Scheduled Weekly Hours : 40
Job Category : Administration
Company : Clinical Pathology Laboratories, Inc.
Sonic Healthcare USA is committed to creating a diverse and inclusive workplace. We welcome applications from all qualified individuals and prohibit discrimination in the workplace.
