Director Physician Services, Audit and Compliance

UPMC

Date: 06/05/2020

Location: Pittsburgh

The Director Physician Services, Audit and Compliance is responsible for staying current with and identifying emerging risks and regulations in healthcare that could affect the company. The primary responsibilities of this position are to manage and deliver internal audit and compliance activities to assure they are conducted according to professional standards with the goal of maximizing value for the company. Current activities include physician and advanced practice professionals billing and coding audits, internal audit engagements throughout the system, data analytics, process improvement projects, special investigations and special projects as requested by management. Compliance functions include all seven elements of an effective compliance program. Direct multiple projects concurrently including refining the scope based on risk assessment, executing fieldwork, workpaper review, preparing reports and monitoring of followup. Present audit conclusions and value-added recommendations to Senior management that reflect a strong understanding of company objectives and capabilities, control requirements, and industry best practices to facilitate change in a constructive and collaborative manner. Assist the departmental senior leadership team in developing risk assessments and the annual compliance and audit plans. Oversee the execution and review of work of auditors and analysts to assure work is of high quality, timely and in accordance with overall department objectives and guidelines. This position will identify trends with billing and coding a well as audit and consulting best practices that can be implemented in the department in order to more effectively provide value to our customers. Supervise, mentor, and provide performance management for staff working on assigned engagements. Participate in the interview process of potential auditors and analysts and provide strong leadership in recruiting, building and developing talent at various

Qualifications

  • Bachelor's degree in legal, accounting or other related business field required. 
  • Minimum of six years of experience with a CHC, CIA or other relevant certification; risk and control-focused areas such as regulatory or internal auditing or equivalent experience in a health care field is required. 
  • Significant leadership experience required. 
  • Relevant professional certification is required. 
  • Master's degree and/or Six Sigma Certification are preferred. 
  • Significant experience in a management capacity. 
  • Strong understanding of risk analysis and process improvement. 
  • Superior technical skills, including superior knowledge in Access, Excel, Power Point, Visio and SharePoint.  
  • Knowledge of industry standard project management tools, methods and reports.  
  • Excellent verbal and written communication skills with the ability to work effectively with all levels of the organization. 
  • Relevant professional certification is required. (CPA, CIA, CMA, others)

  • Learn more and apply below.