The Audit Manager is responsible for managing third party payer/agency audit requests and supporting the Director of Compliance/Privacy Officer in implementing and executing the compliance program within Mom’s Meals to include privacy, grievance, and critical incident reporting.
Position Responsibilities may include, but not limited to
Promotes good public relations as a representative of Mom’s Meals and the compliance department in communicating with outside parties including clients and third-party payers
Develops, maintains, and manages audit requests using internal tracking system, including all documentation provided to payer/agency
Develops and maintains audit process for payer/agency audits requested by outside parties both on-site and remote desk audits
Track and coordinate all internal communication and document retrieval for audits
Reviews payer/agency contracts and applicable federal/state/agency regulations to proactively determine any potential negative audit findings
Notifies employees/internal customers of changes in federal, state and/or third-party payer and/or agency rules and regulations
Drafts Corrective Action Plans (CAPs) with appropriate internal customers and compliance team in response to audit findings
Identifies and tracks trends in auditing to ensure proactive preparation for future audits and/or determinations resulting in CAPs
Leads policy development/updates and compliance projects as assigned
Provides education on a regular and as needed basis in the area of compliance for new employees and ad hoc for identified customer groups
Assist in management of critical incidents and grievances received by clients or payers/agencies Required Skills & Experience
Bachelor’s degree in business or healthcare related field or 4 years relevant experience in auditing and/or payer relations in healthcare
2 years minimum experience in auditing and/or payer relations in the healthcare industry Strong problem solving skills to include developing and analyzing options and recommending solutions
Ability to prioritize (and re-prioritize) projects in a fast-paced work environment
Effective communication skills, both written and verbal
Ability to work collaboratively to foster trust, credibility, and understanding Ability to promote teamwork within department and organization Effective organizational skills to meet deadlines, complete audits and/or accomplish time sensitive work prior to due dates Maintain working knowledge and understanding of various state and federal rules and regulations related to Medicare/Medicare Advantage plans, Medicaid, and laws regarding confidentiality, compliance, and release of information Maintain working payer/agency requirements for billing and compliance with home delivered meals, including Medicare Advantage plans, Medicaid/Medicaid MCOs, Area Aging Agencies and other sources of payment including client self-pay Strong customer service mindset Preferred Skills & Experience ..
Repetitive motions that include the wrists, hands and/or fingers
Sedentary work that primarily involves sitting, remaining in a stationary position for prolonged periods
Visual perception to perform job including peripheral vision, depth perception, and the ability to adjust focus. Company Overview
Mom’s Meals, is a home-delivered meal service providing fully prepared, refrigerated meal solutions direct to homes nationwide for over 18 years. We provide seniors, patients recovering post-discharge and those managing a chronic condition with tailored nutrition solutions to manage their specific needs. If you are passionate about the well-being of others and have a strong sense of community, Mom’s Meals could be the place for you! We are a family operated business looking for fun, compassionate, and friendly people who want to make a difference in the lives of others.
Mom’s Meals complies with all applicable federal and state non-discrimination laws. All qualified applicants shall receive consideration for employment without regards to race, religion, national origin, ancestry, color, gender, age, disability, sexual orientation or military status.
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