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Compliance Audit Manager

Location: West Columbia, South Carolina
Work Setting: Hospital
Job Function:
HIM Manager/Supervisor
Job Type:


Voted one of South Carolina’s “Best Places to Work” for 2019, the Lexington Medical Center Physician Network includes more than 450 physicians and advanced practice providers at 75 locations across the Midlands.

From general medicine and orthopedics to oncology and neurosurgery, these dedicated physicians, specialists and surgeons combine the highest quality care with advanced medicine and state-of-the-art technology to help patients achieve the best possible outcomes. As the third largest employer in the Midlands, we invite you to be a part of our ongoing success and join our LMC Family.

Job Description

Job Summary
This position is responsible for assisting with the day-to-day operations of the Compliance auditing functions for the Lexington Medical Center Compliance department. Manages day-to-day coding compliance operational processes for auditing and monitoring and is the subject matter expert on auditing software used within the department. Responsible for staff quality audits and monitoring staff work for consistency and accuracy. Assists with provider coding compliance audits, written reports, and other focused audits as assigned. The position assists with system-level project planning, problem resolution, personnel management and performance improvement and reports to the Lexington Medical Center Chief Compliance Officer

Essential Functions
Stays current with changing regulations, policies, procedures and standards impacting professional compliance as well as coding guidelines.
The individual effectively identifies and analyzes areas of weakness; research causes and formulates recommendations that enhance operations and compliance.
Assists with special projects and investigations as directed.
Analyzes audit findings and reports/tracks results for Board reporting.
Researches all relevant materials including but not limited to regulations, policies, procedures, and other standards such as CPT coding guidelines and CMS policies.
Documents audit work, findings and reporting of charge corrections to Revenue Integrity in accordance with department standards.
Assists the CCO with questions, gathers data, integrates and interprets data with the intent to report information and provide an analysis and recommendation of findings.
Familiarizes self with area of audit under review.
Researches and gathers all relevant materials including but not limited to regulations, policies, and procedures, coding guidelines, and CMS rules regulations.
Documents findings in accordance with department standards, communicates findings as directed by management and provides an analysis of findings with recommendations.
Performs special projects, audits, and investigations as requested by management as needed or assigned.
Performs special projects, coding and compliance audits based on identified risk areas or targeted audits (e.g., OIG work plan, RAC reviews, research billing, and physician compensation.)
Assists, creates and delivers presentation material.
Complies and maintains information related to professional compliance audits across the health care system.
Responsible for staff quality audits, performance and providing feedback to staff via reports and staff education.
Provides courtesy and friendly service.
Develops productive working relationships with all levels of management, staff and providers.
Provides one-on-one and/or group meetings with auditing staff and providers regarding coding/compliance education.
Assists with the development and delivery of appropriate compliance training and education to compliance staff and providers across Lexington Medical Center.

Duties & Responsibilities
Responds to inquiries on how best to code, document and bill for services provided.
Maintains current knowledge of CPT and ICD coding guidelines as well as CMS policy and regulations.
Must maintain current knowledge of governmental policies such as local and national coverage decisions along with CMS rules and regulations impacting professional compliance.
Reads trade journals articles related to coding and compliance and shares knowledge with peers and customers.
Requires strong leadership, investigative, and coding skills.
Advanced and demonstrated ability to research regulations, coding queries and understands professional billing and reimbursement methodologies.
Must be familiar with reference sources and have the ability to navigate and link various sources of regulations and standards.
Advanced knowledge of the audit and monitoring program for facility and professional coding requirements.
Must be able to understand, demonstrate, and teach professional compliance, billing and coding compliance to others.
Requires excellent verbal and written communication skills.
Must be able to educate physicians, mid-level providers, support staff and administration on medical record documentation requirements as set forth by the Federal Documentation Guidelines as well as other compliance education areas and audit findings.
Ability to assist in developing audit work plans based on data analysis of potential risk areas.
Works independently on “ad-hoc” and routine assignments.
Manages time effectively and regularly meets expected deadlines.
Ability to work well with others and conduct work in respectful manner.
Follows normal business protocol.
Demonstrates a positive attitude and positive communication.
Maintains appropriate professional conduct, appearance and language.
Performs all other duties as assigned.

Required Qualifications

Minimum Qualifications

Minimum Education: Bachelor’s Degree from an accredited University in Business, Healthcare Administration, or related field.
Minimum Years of Experience: 5 Years of experience in healthcare auditing, coding, revenue cycle, legal, or regulatory compliance; 2 Years of experience in which supervisory and/or leadership has been demonstrated. This can be concurrent with required 5 Years of experience in healthcare auditing, coding, revenue cycle, legal, or regulatory compliance.
Substitutable Education & Experience (Optional): None.
Required Certifications/Licensure: Coding certificate (CPC or CCS-P); Certified Professional Medical Auditor certification (CPMA).
Required Training: None.


Day ONE medical, dental and life insurance benefits
Health care and dependent care flexible spending accounts (FSAs)
Eligible employees may also enroll in LMC’s retirement plans on their date of hire, including the South Carolina State Retirement System (SCRS)
Supplemental 401(k)
457(b) retirement plans
Free life insurance – equal to 1x salary
Adoption assistance
401(K) Match – LMC matches dollar for dollar up to 6%
LMC provides its full-time employees short-term disability and long-term disability coverage after 90 days of eligible employment
529 College Savings
Tuition reimbursement
Student loan forgiveness

Instructions for Resume Submission


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Posted: September 30, 2020 at 3:29 PM
Post ID: 54796

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