Claims Quality Audit Director jobs in Peoria, IL

Expected pay for this position is $56.87 - $75.35/hour. Actual pay will be determined by experience, skills and internal equity.

POSITION SUMMARY:

The Director of Compliance Audit is accountable for leading the essential functions of the OSF Compliance and Audit Program in the specified areas of responsibility. In this role, the Director focuses on Compliance related risks primarily dealing with billing and coding and clinical documentation to determine compliance with applicable OIG, CMS, and MAC requirements. Responsible for overseeing the Compliance Audit Program across the organization (hospitals, provider practices, and home care), which includes: internal reimbursement/billing compliance audits, internal clinical documentation audits, and MAC, RAC, SMRC, CERT and other government contractor audits.

REQUIRED QUALIFICATIONS:

Education:

• Master’s degree

Experience:

• 5 years of health care compliance
• 3 leadership experience

Licensure/ Certification:

• Professional certification in Compliance or a related field; or must obtain within 24 months of hire into position.

Other Skills/ Knowledge:

• Excellent interpersonal and communication skills.
• Solid computer skills, including proficiency with Microsoft software.
• Strong analytical and problem-solving skills, with the ability to be detail oriented.
• Must possess high ethical standards with ability to build teams and relationships with results orientation and commitment to staff development.
• Working knowledge of the elements of an effective compliance program.
• Working knowledge of OIG, DOJ and OCR materials.
• Working knowledge of the FCA, the Stark Law, the AKS, the CMP Law and the HIPAA Privacy Rule.
• Ability to: Apply statutory, regulatory and policy provisions to everyday clinical and business activities, explain often complicated requirements in a clear and helpful way and Discern underlying concerns, problems and root causes.

PREFERRED QUALIFICATIONS:

Education:

• Master’s degree in business, Healthcare Administration, other related field

Experience: N/A

Licensure/ Certification: N/A

Other Skills/ Knowledge: N/A

OSF HealthCare is an Equal Opportunity Employer.