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Director Physician Services, Audit and Compliance

Company: UPMC
Location: Pittsburgh
Posted on: September 13, 2020

Job Description:

At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

Job Title: Director Physician Services, Audit and Compliance

Job ID: 78916338

Status: Full-Time

Regular/Temporary: Management

Hours:

Shift: Day Job

Facility: Corporate Finance

Department: Internal Audit

Location: 3600 Forbes Ave, Pittsburgh PA 15213

Description

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 providers.

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 activities.

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 topics.

Departmental Goals andTime Management: Contributes todefining and meeting departmental goals. Successfully manages many competingdemands and is able to deliver projects on time and within budgeted hours.

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 of UPMC.

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 the client.

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 ACL).

Leadership skills:

Participates in andfrequently leads departmental special projects.

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 effectiveness.

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 internal auditing.

Completes performancereviews on audit projects and contributes to coworkers and staff.

Performs in accordancewith system-wide competencies/behaviors.

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 findings.

Open items and reviewcomments are fully tracked and closed within timeframes.

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

with client.

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 Compliance Committee.

Qualifications

Bachelor's degree in legal, accounting or other related business field required.

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 preferred.

Significant experience in a management capacity.

Strong understanding of risk analysis and process improvement.

Superior technical skills, including superior knowledge in Access, Excel, Power Point, Visio and SharePoint.

Knowledge of industry standard project management tools, methods and reports.

Excellent verbal and written communication skills with the ability to work effectively with all levels of the organization.

Relevant professional certification is required. (CPA, CIA, CMA, others)

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

UPMC VALUES At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC VALUES

QUALITY & SAFETY

DIGNITY & RESPECT

CARING & LISTENING

RESPONSIBILITY & INTEGRITY

EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

UPMC Health Plan Named Best Places to Work for LGBTQ Equality in 2020 UPMC Ranked #1 Best Places for Women and Diverse Managers in 2019

Keywords: UPMC, Pittsburgh , Director Physician Services, Audit and Compliance, Other , Pittsburgh, Pennsylvania

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