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Senior Clinical Audit Manager - Remote (Anywhere US)
Job ID R26155
Date posted 04/06/2022
Senior Clinical Audit Manager
Overview of Position
The Sr. Clinical Audit Manager is responsible for managing the Payment Integrity Clinical Validation and Hospital Billing Validation Audit teams. The Sr. Clinical Audit Manager will network and maintain effective communication with internal and external personnel including staff, clients, and management to ensure audit accuracy and integrity in accordance with client contracts and guidelines. The Sr. Clinical Audit Manager will be responsible for program and product development, day-to-day operations and processes, and quality assurance.
What will be my duties and responsibilities in this job?
Utilize audit experience and industry best practices to lead a team of Clinical Auditors to deliver timely and accurate audit results
Direct training and professional development for the clinical team
Ensure accuracy of audits through acquired knowledge of client policies and contract information
Assist in the development and support of analysts to meet and exceed documented productivity standards
Performance of periodic quality assurance reviews and documentation analysis of audits to ensure consistency and accuracy in accordance with evidence-based criteria, client expectations, and contractual requirements
Training of audit staff in accordance with internal policies and procedures to assure consistency and accuracy of HBV reviews
Identify and review potential clinical audit inconsistencies, target areas of improvement and product development, and communicate findings with management and audit staff
Act as a point of contact and resource for clinical staff
What are the requirements needed for this position?
Graduate of an accredited College or University with an active and unrestricted R.N. license
5 years of management experience
What critical skills are needed for you to consider someone for this position?
Diverse acute care clinical nursing experience
Clinical post payment auditing experience
Experience with national evidence-based screening guidelines
Ability to perform in-depth analysis of documentation relating to appropriateness of clinical documentation
Experience with inpatient coding requirements and competency in ICD-10 CM & PCS
Willingness to engage in both tactical hands-on work and strategic work, as needed, to manage and complete priorities
Ability to work independently and drive execution by understanding actions and performance necessary to motivate staff and provide an environment that strives for continuous improvement
Strong leadership skills with the ability to clearly communicate verbal or written expectations; outlines goals and objectives for all levels of staff within the team to achieve success
Excellent analytical, organizational, and prioritization skills
Ability to interface with all levels of the company including clients
Ability to manage multiple, concurrent priorities effectively in a fast-paced environment
Proficiency with Microsoft office and Excel
What other skills/experience would be helpful to have?
Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA), or equivalent coding certification preferred
Bachelor’s degree preferred
What are the working conditions and physical requirements of this job?
General office demands/Home office
How much should I expect to travel?
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COVID Vaccination Requirements
We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.
Equal Opportunity/Affirmative Action Statement
Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.
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Talent Acquisition Process
Once you apply for a job opening, the Sourcing Specialist or Talent Advisor will review your resume ensuring your background matches the minimum job requirements. Selected candidates will be invited for a phone screen.
Steps will vary by team, but typically include: Talent Advisor phone screen, hiring manager interview, and a combination of technical screens and panel interviews.
If you're selected, you can expect the Talent Advisor to reach out with specific offer details. During this stage you will be provided with an electronic offer letter and other new hire documents.
Once you've electronically signed your offer, our onboarding team will get you ready for Week 1 and set you up for success! Onboarding tasks may include a background check, drug screening, and other job specific requirements.
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