Title

Director of Compliance Audit and Investigations 


About the Organization CommuniCare Family of Companies is a privately held, multi-faceted healthcare management company in operation since 1984 that specializes in nursing homes, assisted living facilities and rehabilitation units. Our company's historic passion for excellence is evident in every facet of our service continuum. We are leaders in the long-term care industry and operate over 40 facilities across Ohio, Pennsylvania, Maryland and Missouri, employing more than 7,000 dedicated care personnel. We're excited about your interest in joining CommuniCare and your desire to uphold our mission of Caring with Purpose and Caring with Pride.  

Location Information  

Description

Director of Compliance Audit and Investigations

The CommuniCare Family of Healthcare Companies is currently seeking a healthcare professional to contribute to the success of our Corporate Compliance Program by acting as Director of Compliance Audit and Investigations.

Qualified candidates for this position will have a Bachelor's degree in a healthcare-related field, and 3 or more years of related work experience. Candidates must have experience in a Medicare and Medicaid regulatory environment, including experience researching Federal and State coding and reimbursement guidelines and regulations. Two or more years recent Long Term Care experience preferred, with an emphasis on experience with inpatient/outpatient coding, ability to follow standard procedures for coding and reimbursement, and significant exposure to healthcare compliance concepts and audits. Formal audit experience preferred. This position requires advanced skills in Microsoft applications with the ability to produce complex documents, perform analyses, and maintain databases. Responsibilities of the position demand excellent communication skills, both verbal and written, and the ability to work as part of a team.

Responsibilities of the position will include:

  • Perform audits to assess compliance with Medicare and other third party coding and billing requirements.
  • Assist with responses to government and other external audit or investigative requests.
  • Support the oversight of all Privacy related matters across the organization.
  • Provide input in improvement of audit policies and procedures.
  • Assist with the development of annual Compliance Program Work Plan.
  • Support facility and regional leadership in all compliance/audit related questions.
  • Assist with preparation of reports based on audits with appropriate recommendations and perform subsequent audits to ensure corrective action.
  • Support development of educational materials based on audit findings for use in quality improvement and feedback.
  • Monitor and inspect physical operations, organization policies and procedures, documentation, etc., to develop an understanding of areas audited and investigate for irregularities.
  • Screen and analyze computer-generated data, including data from mechanized claims processing systems.
  • Review medical records for any inconsistencies with beneficiary diagnosis and treatment.
  • Participate in exit conferences.
  • Serve as a senior compliance team member to ensure that an effetive compliance program is functioning.
  • Travel as needed to effectively perform job duties.

CommuniCare is proud to offer our employees competitive salaries in a friendly, team atmosphere, along with our outstanding benefit package for full time associates. Qualified candidates, forward your resume for confidential consideration.

 

Position Requirements
  • Bachelor's degree in healthcare related field required.
  • 3+ years related work experience required.
  • Formal Audit experience preferred.
  • 2 or more years' recent experience in Long Term Care preferred, including inpatient/outpatient coding (i.e. MS-DRG, APC, ICD-9/HCPS/CPT, RUG III/IV, MDS, etc.). Must demonstrate knowledge of coding and ability to follow standard practices in coding and reimbursement in order to perform this role. 
  • Significant exposure to healthcare compliance concepts and compliance auditing.
  • Experience in Medicaid and Medicare regulatory environment, including experience with researching Federal and State coding and reimbursement guidelines and regulations.
  • Advanced skills with Microsoft applications, which may include: Outlook, Word, Excel, PowerPoint, Access, or other web-based applications. May produce complex documents, perform analyses, and maintain databases.
  • Must be a team player.
  • Exellent Written and Verbal communication skills a must.
 

Full-Time/Part-Time Full-Time  

Location CommuniCare Health Services - Corporate Office  

Shift -not applicable-  

Experience Level 3 or more years related work experience. 2 or more years LTC preferred. Formal Audit experience preferred.  

Education Level Bachelor's degree in healthcare-related field.  


This position is currently not accepting applications.

To search for an open position, please go to http://CommunicareHealth.appone.com



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