Assistant Director of Compliance - Reg. Gov. Audit Response

About UI Health

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois at Chicago (UIC), UI Health comprises a clinical enterprise that includes a 495-bed tertiary care hospital, 22 outpatient clinics, and 13 Mile Square Health Center facilities, which are Federally Qualified Health Centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity.

Position Summary

The position of Assistant Director of Compliance-Regulatory Audit and Government Response works in partnership and collaboration with Hospital Revenue Cycle, Utilization Management, Health Information Management, Clinical Documentation Improvement, and cross-functional teams, as applicable to support efforts with responses to government audit findings/inquiries as related to organizational federal and state reimbursement. This position assists in the development, interpretation, and implementation of requirements for response and interactions for government audits, i.e., Office of Inspector General ("OIG"), Centers for Medicare & Medicaid Services' ("CMS"), Recovery Audit Contractor ("RAC") programs. This position is a compliance resource and accountable for the daily management, monitoring, and direction of government response audits and government activities. This position ensures alignment with UIH government audits and key objectives.

Duties & Responsibilities

• Establishes and maintains productive working relationships with all levels of the organization, including senior management and frontline employees to serve as compliance resource in government responses and actions related to responses to reimbursement audit-related findings/inquiries
• Coordinates, initiates, monitors, and responds to all audit requests/demands and facilitates timely reviews, appeals, and routing of and response to government (federal, state, contractors)
• Performs research, gathers financial data, and coordinates focused audits on Medicare and Medicaid billing to analyze, summarize, prepare reports, and make recommendations.
• Maintains knowledge base and coordinates with internal/external subject matter experts on laws, regulations, and organizational policy and procedures as necessary and ensures review of documentation/ information by internal subject matter experts prior to submission.
• Assists interdisciplinary teams in identifying and prioritizing areas of process improvement and develop/implement processes and tools to mitigate risk.
• Monitors legal developments and facilitates communication with external regulatory authorities (OIG, CMS, HFS, Medicare, etc.) regarding audit/finding matters
• Maintains subject-matter expertise reimbursement audits, regulatory, billing/documentation regulations and related organizational policies and procedures
• Monitors Medicare/Medicaid regulatory reimbursement related to updates and changes in healthcare landscape
• Initiates and monitors the appeal processes, including escalation of procedural gaps
• Uses data or maintains database(s) to track/trend data for stakeholders and key leadership
• Tracks issues and presents critical information and updates to key stakeholders
• Drafts and periodically reviews audit policies, procedures, and trainings
• Makes recommendations for new policies and procedures as necessary
• Leads or collaborates on compliance investigations and other reported compliance concerns
• Collaborates and oversees third-party/external audit vendors/partners in facilitation of workplan initiatives
• Creates applicable policies, guidance, and work process flows for risk mitigation
• Provides compliance guidance to business units, consult on internal initiatives to ensure compliance with laws and regulations
• Models ethical conduct and encourages ethical behavior and business practices throughout the organization
• Manages internal and external regulatory audit communications for all audit-related correspondence
• Continuously evaluates processes in preparation for audit requests and in response to audit findings
• Promotes organizational compliance awareness of the compliance program and available resources
• Performs other related duties and participate in special projects as assigned
• Perform other related duties and participate in special projects as assigned.