Medicare Rac Audit Jobs in Illinois (NOW HIRING)

Description

Location: HYBRID; 2-3 days in Park Ridge, IL office

Compensation: The annual base salary range for this position is $115,000 - $130,000.

Job Description 

The Compliance Program Manager assists the VP Compliance in providing compliance oversight and establishing and maintaining an effective compliance program to promote awareness of, and compliance with, applicable laws, regulations, policies and standards.  

Core Responsibilities  

• Assist in development of organizational compliance auditing/monitoring activities, including periodic reviews of the individual department auditing/monitoring functions; 

• Ongoing management of the organization's Hotline and case management system; 

• Assist in promotion of a corporate culture that fosters ethical and compliant behaviors and provides the basis for ensuring adequate controls to maintain compliance with law, regulations, and payer requirements throughout the organization.  

• Interpret statutes, regulations, and regulatory communications for potential impact on the organization and its operations; 

• Develop and implement policies, procedures, and practices designed to ensure compliance with the Office of Inspector General, Federal health care program requirements, and other applicable laws and regulations.   

• Work closely with all departments for effective investigation, resolution, reporting, and remediation of compliance issues. Provide guidance to staff as appropriate to ensure departmental direction is effectively executed.
• Manage medical record retrieval, review, and submission for CMS and government payer audits, ensuring timely and accurate responses.
• Coordinate documentation requests for multiple CMS audit programs, including Recovery Audit Contractors (RAC), Targeted Probe and Educate (TPE), Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractor (SMRC), Medicare Administrative Contractors (MAC), Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), and Medicaid Integrity Contractors (MIC) audits.
• Review clinical documentation to ensure compliance with Medicare, Medicaid, CMS, and payer-specific billing and documentation guidelines.   

Skills 

• Knowledge of State and Federal laws and regulations that effect the provision of health care and health care organizations, including laws, regulations, policies, and requirements applicable to health systems including Medicare and Medicaid, insurance reimbursement, fraud and abuse laws, accreditation, licensing, and certification standards.   

• Knowledge of ethics and compliance program elements, principles and practices, privacy, security, internal controls, and audit functions.   

• Experience assessing compliance risk, interpreting, and applying applicable laws, regulations, policies, procedures, and professional practice standards for compliance and integrity programs.   

• Highly analytical with strong attention to detail.   

• Ability to multi-task in a fast-paced environment while maintaining an exemplary level of organization, productivity, and accuracy.   

• Analytical skills and objective judgment to effectively manage problem resolution. Self-driven with excellent interpersonal and presentation skills.  

• Excellent oral and written communication, organization, and time management skills.  

• Knowledge of compliance investigation and auditing principles and standards.   

• Proven ability to assess complex situations and prioritize multiple projects and demands. 

Requirements

• Bachelor's degree and minimum of 3 years working experience in compliance in a healthcare setting. 

• Certified in Healthcare Compliance (CHC) credential preferred.
• Candidates who do not currently hold a CHC certification must be willing and able to obtain certification within six (6) months of hire. The Company will sponsor the certification process.