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Job Title: Director Physician Services, Audit and Compliance
Job ID: 78916338
Shift: Day Job
Facility: Corporate Finance
Department: Internal Audit
Location: 3600 Forbes Ave, Pittsburgh PA 15213
The Director Physician Services, Audit and Compliance is
responsible for staying current with and identifying emerging risks
and regulations in healthcare that could affect the company. The
primary responsibilities of this position are to manage and deliver
internal audit and compliance activities to assure they are
conducted according to professional standards with the goal of
maximizing value for the company. Current activities include
physician and advanced practice professionals billing and coding
audits, internal audit engagements throughout the system, data
analytics, process improvement projects, special investigations and
special projects as requested by management. Compliance functions
include all seven elements of an effective compliance program.
Direct multiple projects concurrently including refining the scope
based on risk assessment, executing fieldwork, workpaper review,
preparing reports and monitoring of followup. Present audit
conclusions and value-added recommendations to Senior management
that reflect a strong understanding of company objectives and
capabilities, control requirements, and industry best practices to
facilitate change in a constructive and collaborative manner.
Assist the departmental senior leadership team in developing risk
assessments and the annual compliance and audit plans. Oversee the
execution and review of work of auditors and analysts to assure
work is of high quality, timely and in accordance with overall
department objectives and guidelines. This position will identify
trends with billing and coding a well as audit and consulting best
practices that can be implemented in the department in order to
more effectively provide value to our customers. Supervise, mentor,
and provide performance management for staff working on assigned
engagements. Participate in the interview process of potential
auditors and analysts and provide strong leadership in recruiting,
building and developing talent at various levels. Responsibilities:
Compliance Activity: Lead the physicianservices audit and
monitoring function over billing and coding for all care
Identify a risk-basedapproach to the audits that include
consideration of the OIG Workplan,NCD/LCDs, and billing guidelines
that are new, changed, or frequentlyidentified as complex or having
inappropriate billing issues.
Utilize data analyticsto qualify the population and target
samples that best protect UPMC as well asevaluate the accuracy of
clinical documentation and billing.
Develop and managecompliance programs to achieve compliance with
regulations, rules and standardsor conduct.
Establish policies andprocedures to support compliance
Plan, develop andconduct communications and educational and
training sessions related tospecific compliance topics.
Establish monitoringmechanisms and conduct routine audits and
compliance programs. Overseecoordination and facilitation of the
work of compliance officers/liaisonsacross assigned areas as well
as individuals and groups throughout these
UPMCdepartments/divisions, across a wide range of compliance
Departmental Goals andTime Management: Contributes todefining
and meeting departmental goals. Successfully manages many
competingdemands and is able to deliver projects on time and within
Assists the departmentin making sure that staff analysts and
auditors are productive and haveadequate work load.
Meets departmentalgoals for productivity and monitors deadlines
for reports, follow-up and Boardreporting. Proactive in identifying
staff downtime and assists in helping staffto stay productive.
Identifiesopportunities for process improvements within the
department and efficientresolutions for them.
Industry &Technology Skills:
Possesses strongunderstanding of business process controls. Has
developed specialized skills inthe industry or specific divisions
Possesses advanced knowledge ofinternal and external control
expectations, including UPMC Standards, GAAP,IIA, COSO, Six Sigma,
fraud and SOX.
Utilizes various infonet, social media andcommunication tools
available in the organization to communicate compliancetopics.
Contributes to ongoing departmental goal of entity-wide
riskidentification and logging for the creation of both the
compliance and audit plans.
Possesses solidunderstanding of healthcare terminology, billing
and coding regulations andguidelines and industry risks,
understands their impact on UPMC, and can serveas a resource to
clients for inquiries.
Able to research andanalyze new business processes and new
programs to identify key controls andrisks as well as conflict of
interest and regulatory considerations.
Able to conduct awalk-through and demonstrate a strong
understanding of business
processes and createor supervise a process flow to review with
Able to utilizeunderstanding of complex business processes and
issues and UPMC as a whole torecommend appropriate controls to
mitigate risks while aligning with strategicgoals, business
objectives and regulatory expectations. Maintain a
strongunderstanding of the applicable billing applications to
assess and developsolutions when issues are identified.
Possesses advancedauditing and software skills with department
applications (Microsoft Office,Audit Workpaper Software, and
Participates in andfrequently leads departmental special
Assists in developing and maintainingdepartment independence,
professionalism, and reputation.
Participates indepartmental meetings, including, contributing to
agenda, presenting andeducating co-workers.
Possesses strong public speaking skills and is
comfortableleading opening and closing meetings, including
explaining issues to executivesand handling constructive
disagreements to resolution.
Assures that theappropriate levels of UPMC management are aware
of projects and issues.
Mentors and/ordevelops staff skills, judgment, and
Facilitates individualas well as staff and departmental team
work and team building.
Provides constantfeedback to staff analysts and auditors on
their performance and is able totrain staff analysts and auditors
on appropriate tools and techniques ofauditing and monitoring and
Completes performancereviews on audit projects and contributes
to coworkers and staff.
Performs in accordancewith system-wide
Performs other dutiesas assigned.
Professionallyrepresents the CACO, VP or Director at delegated
meetings or projects. Developsand maintains a resource network of
contacts and effective workingrelationships with executive
management within UPMC, as well as externalleaders and peers.
Workpaper &Report/ Deliverable Preparation:
Uses, reviews, andinitiates revision of the standard department
templates and processes forperforming internal audits as well as
auditing and monitoring.
Capable of developing completelynew work programs and testing
steps to be included on audit programs.
Workpapers arecompleted on time
and evidence isorganized to fully support conclusions and
Open items and reviewcomments are fully tracked and closed
Provides substantivereview notes and establishes reasonable
deadlines to auditors.
Identifies root causeof complex issues and proposes valuable and
effective solutions, with knowledgeof UPMC organization.
Tracks and trendsissues identified in auditing and monitoring
results to provide appropriate communication andeducation as well
as determine future approaches to audits and sample sizing tobest
identify and resolve issues proactively.
Reviews all workpapersas appropriate and finalizes report drafts
for review by Management.
Reports areprofessional, complete, practical, based on accepted
standards, and allfindings validated
Follow-up for pastaudits is tracked and performed within
timeframes to meet reportingrequirements.
Monitors and tracksall audits under supervision for proper
inclusion and reporting to the AuditCommittee and the Ethics and
Bachelor's degree in legal, accounting or other related business
Minimum of six years of experience with a CHC, CIA or other
relevant certification; risk and control-focused areas such as
regulatory or internal auditing or equivalent experience in a
health care field is required.
Significant leadership experience required.
Relevant professional certification is required.
Master's degree and/or Six Sigma Certification are
Significant experience in a management capacity.
Strong understanding of risk analysis and process
Superior technical skills, including superior knowledge in
Access, Excel, Power Point, Visio and SharePoint.
Knowledge of industry standard project management tools, methods
Excellent verbal and written communication skills with the
ability to work effectively with all levels of the
Relevant professional certification is required. (CPA, CIA, CMA,
Licensure, Certifications, and Clearances:
Relevant professional certification is required. (CPA,
CIA, CMA, others)
UPMC is an Equal Opportunity Employer/Disability/Veteran Salary
Range: $0 / hour
Union Position: No
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