Compliance Audit Manager

About the role

With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!

Works under minimal supervision reporting to the AVP of Compliance/Chief Compliance Officer, to perform assessments of risk related to health care reimbursement through third party payers, particularly Medicare, Medicaid, and other government payers, managed care payers, and the like. This role uses sources such as the OIG Work Plan, payer alerts, probe audits and internal reviews and reports from monitoring activities; methodologies such as probe auditing, statistical sampling and extrapolation; and technologies such as Microsoft Office (e.g., Excel), MDAudit, Med Analytics, electronic medical records, and other applicable tools and methodologies, to identify, quantify, and make recommendations regarding reimbursement errors and opportunities and corrective actions, for UTSW health care facilities and providers. Performs and/or manages various assurance activities to determine departmental/unit/program adherence to internal controls, education/training requirements and compliance with established policies and procedures. Oversee coding and billing compliance activities to ensure adherence to federal and state regulations, payer requirements, and institutional policies. Manage and conduct risk-based audits of professional and facility billing, coding accuracy, documentation, and reimbursement practices. Supervise compliance staff, establish performance expectations, and ensure timely completion of audits, investigations, and advisory requests. Identify billing and coding risks, analyze trends, and recommend corrective actions to mitigate regulatory and financial exposure. Collaborate with Revenue Cycle, Clinical Departments, and operational leadership to address compliance concerns and strengthen internal controls. Oversee corrective action plans, including monitoring, validation, and reporting of remediation efforts. Provide guidance and education regarding Medicare, Medicaid, and other payer requirements, including documentation, coding, and billing standards.

Responsibilities

• Manages auditing of reimbursement issues for UTSW health care providers and entities, including the claims incurred in UTSW hospitals and clinics, affiliate hospitals, ambulatory locations, and clinical trial billing.
• Assists the UTSW AVP of Compliance/Chief Compliance Officer in responding to third party payer audit requests as well as identifying and auditing significant reimbursement errors and opportunities, focusing on determination of error rates, mitigation strategies, makes recommendations for performance improvement.
• Provides compliance assistance to impacted providers