External Audit Manager

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Job Description

This position is charged with reviewing and assembling medical record documentation prior to contractor submission in a manner that conveys documentation, medical necessity, and coding requirements have been met. The manager will remediate all audit dispositions including audit contractor questions and requests, arguing cases at contractor meetings, writing appeal letters, and participating in proceedings with administrative law judges when applicable.

The manager will collaborate regularly with key stakeholders internal and external to the Compliance Department, including but not limited to Patient Accounting, Revenue Cycle, Finance, Case Management, and a variety of other Care Team members to implement internal controls, mitigate risk, and improve operations.  This position will ensure the creation of and adherence to applicable policies and procedures relating to recovery audit contractors as well as provide applicable education and training. The External Audit Manager will also stay abreast of proposed and approved recovery audit contractor issues as well as associated regulations, interpretive guidelines, and local and national coverage determinations to assist stakeholders and safeguard the compliance program.

Manages two or more professional and support staff including subordinate supervisors. Typically has hire, fire, or promotion authority. Evaluates and makes improvements to department processes while ensuring compliance with organizational policies and applicable laws and regulations. More discretion and greater financial authority than other lower management levels. Manages initiatives, strategic priorities and programs which have an impact on the organization. Works independently and in collaboration with leadership to support the budget process and meeting key operational goals. Plans, organizes, facilitates, monitors, and evaluates activities and functions of the department/functional business area based employee/organizational goals. Collaborates with leaders to establish operating procedures, enhance clinical/non-clinical workflows, increase productivity, and improve overall quality outcomes and operational efficiencies within a variety of delivery settings.

Additional Job Description

A bachelor’s degree plus a minimum of 10 years work experience in a related field, or a Master’s Degree with 5 years’ work experience in a related field is required. 

Nursing experience preferred. 

Must be proficient in billing, documentation, coding, and medical necessity compliance in a multi-hospital. 

Must have experience with interpreting state and federal payor policies and guidelines including coverage determinations. Strong leadership, consultative and analytical skills are required.  Must exhibit exceptional interpersonal and communications skills and be able to work independently with minimal supervision. 

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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