Assistant Director of Compliance - Chicago - University of Illinois Hospital and Health Sciences System

University of Illinois Hospital and Health Sciences System Chicago

1 week ago

Description

Assistant Director of Compliance - Reg. Gov. Audit Response

Hiring Department: Compliance

Location: Chicago, IL USA

Requisition ID:

Posting Close Date: March 25, 2025

Salary: Thesalary range of employees currently holding equivalent position is $128,708 -$160,067

We strive to provide a competitive salary, considering factors such as available market data, internal equity, candidate experience and qualifications, and budget constraints. The final salary offer will be determined through a thorough assessment of these elements.

About the University of Illinois Hospital & Health Sciences System (UI Health)

The University of Illinois Hospital & Health Sciences System (UI Health) provides comprehensive care, education, and research to the people of Illinois and beyond. A part of the University of Illinois Chicago (UIC), UI Health comprises a clinical enterprise that includes a Joint Commission-accredited tertiary care hospital and outpatient clinics, and the Mile Square Health Center network of federally qualified health centers. It also includes the seven UIC health science colleges: the College of Applied Health Sciences; the College of Dentistry; the School of Public Health; the Jane Addams College of Social Work; and the Colleges of Medicine, Pharmacy, and Nursing, including regional campuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Health is dedicated to the pursuit of health equity. Learn more:

Benefits eligible positions include a comprehensive benefits package which offers: Health, Dental, Vision, Life, Disability & AD&D insurance; a defined benefit pension plan; paid leaves such as Vacation, Holiday and Sick; tuition waivers for employees and dependents. Click for a complete list of Employee Benefits.

Description:

About UI Health

The University of Illinois Hospital & Health Sciences System (UI Health)provides comprehensive care, education, and research to the people of Illinoisand beyond. A part of the University of Illinois at Chicago (UIC), UI Healthcomprises a clinical enterprise that includes a 495-bed tertiary care hospital,22 outpatient clinics, and 13 Mile Square Health Center facilities, which areFederally Qualified Health Centers. It also includes the seven UIC healthscience colleges: the College of Applied Health Sciences; the College ofDentistry; the School of Public Health; the Jane Addams College of Social Work;and the Colleges of Medicine, Pharmacy, and Nursing, including regionalcampuses in Peoria, Quad Cities, Rockford, Springfield, and Urbana. UI Healthis dedicated to the pursuit of health equity.

Position Summary

The position of Assistant Director of Compliance-Regulatory Audit and Government Response works in partnership and collaboration with Hospital Revenue Cycle, Utilization Management, Health Information Management, Clinical Documentation Improvement, and cross-functional teams, as applicable to support efforts with responses to government audit findings/inquiries as related to organizational federal and state reimbursement. This position assists in the development, interpretation, and implementation of requirements for response and interactions for government audits, i.e., Office of Inspector General ("OIG"), Centers for Medicare & Medicaid Services' ("CMS"), Recovery Audit Contractor ("RAC") programs. This position is a compliance resource and accountable for the daily management, monitoring, and direction of government response audits and government activities. This position ensures alignment with UIH government audits and key objectives.

Duties & Responsibilities

Establishes and maintains productive working relationships with all levels of the organization, including senior management and frontline employees to serve as compliance resource in government responses and actions related to responses to reimbursement audit-related findings/inquiries
Coordinates, initiates, monitors, and responds to all audit requests/demands and facilitates timely reviews, appeals, and routing of and response to government (federal, state, contractors)
Performs research, gathers financial data, and coordinates focused audits on Medicare and Medicaid billing to analyze, summarize, prepare reports, and make recommendations.
Maintains knowledge base and coordinates with internal/external subject matter experts on laws, regulations, and organizational policy and procedures as necessary and ensures review of documentation/ information by internal subject matter experts prior to submission.
Assists interdisciplinary teams in identifying and prioritizing areas of process improvement and develop/implement processes and tools to mitigate risk.
Monitors legal developments and facilitates communication with external regulatory authorities (OIG, CMS, HFS, Medicare, etc.) regarding audit/finding matters
Maintains subject-matter expertise reimbursement audits, regulatory, billing/documentation regulations and related organizational policies and procedures
Monitors Medicare/Medicaid regulatory reimbursement related to updates and changes in healthcare landscape
Initiates and monitors the appeal processes, including escalation of procedural gaps
Uses data or maintains database(s) to track/trend data for stakeholders and key leadership
Tracks issues and presents critical information and updates to key stakeholders
Drafts and periodically reviews audit policies, procedures, and trainings
Makes recommendations for new policies and procedures as necessary
Leads or collaborates on compliance investigations and other reported compliance concerns
Collaborates and oversees third-party/external audit vendors/partners in facilitation of workplan initiatives
Creates applicable policies, guidance, and work process flows for risk mitigation
Provides compliance guidance to business units, consult on internal initiatives to ensure compliance with laws and regulations
Models ethical conduct and encourages ethical behavior and business practices throughout the organization
Manages internal and external regulatory audit communications for all audit-related correspondence
Continuously evaluates processes in preparation for audit requests and in response to audit findings
Promotes organizational compliance awareness of the compliance program and available resources
Performs other related duties and participate in special projects as assigned
Perform other related duties and participate in special projects as assigned.

Qualifications:

Minimum Qualifications

This position requires a bachelor's degree in business, law, administration, healthcare, or a healthcare-related degree and a minimum of 2 years of experience in a health-care setting, related experience in reimbursement, billing/collections, denial management, audits, with advanced knowledge of the healthcare industry.
Knowledge of Medicare/Medicaid reimbursement/payment policies, CMS Claims Manual, Local Coverage Determinations (LCDS), Illinois MAC/National Government Services (NGS), American Hospital Association Coding Clinic, Coding; (CPT, ICD-10-CM/PCS), audit reviews and analysis, and medical terminology.
Minimum of 1 year of leadership experience
Knowledge of state/federal healthcare billing requirements. Knowledge and experience in procedures for healthcare government appeals process and Recovery Audit Contractor (RAC) response, AHIMA Health Information Management credentials, (RHIA or RHIT), or comparable experience. Working knowledge of healthcare compliance.
1 year experience with CMS RAC Program Requirements, healthcare billing audits, OIG investigations/inquiries.
Excellent verbal and written skills
Ability to work independently and a team environment
Experience with audit tracking software/tools, MD Audit, Adobe software; EPIC, Cerner software/Systems; Microsoft Planner, TEAMS/Zoom communication platforms

Preferred Qualifications

Master's degree in healthcare administration, business administration, law, or a related master's degree
3 years of healthcare leadership
1 year prior consulting
Skill in change management and process improvement
Excellent problem-solving skills to address difficult, complex issues, and reporting
1 year prior experience in Office of Inspector General ("OIG") audit responses/inquiries
Demonstrated training delivery skills
Experience in Project Management
Ability to manage goals and deadlines while handling multiple projects
Possess strong administrative, analytical, and management skills related to healthcare, finance, and business initiatives
Demonstrated ability to work on cross-functional project teams
Certification in Compliance

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation

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