Your Home for an Exceptional Career.
With the nation’s largest home infusion provider, there is no limit to the growth of your career.
For nearly 40 years, Option Care has been shaping the home infusion services industry. From industry pioneers to trusted partners, Option Care has emerged as the leading home infusion services provider. Our company has grown over 5,000 strong—a workforce that spans the nation and is united by a common passion for making exceptional healthcare synonymous with home.
Job Description Summary:
Reporting to the SVP, Chief Compliance Officer, the Compliance Audit Manager is responsible for auditing and analyzing the clinical and operational work processes, policies and procedures to ensure compliance with all laws, regulations and guidelines with Federal and State programs. Develops and executes monitoring and auditing projects, to include standard, repeatable processes identifying, documenting and presenting any errors, irregularities or findings. Manages Compliance Audit Coordinators and process of responding to payer audit requests timely and accurately, tracking of payer audit activity to include audit findings, appeal and corrective action as well as issuing associated trending reports. Partners with functional leaders to develop responsive and corrective measures in response to audit and monitoring findings and oversees their completion. Serves as the auditor-in-charge when necessary. Serves as a resource both internally and externally regarding compliance-related issues, including the coordination of payer, regulatory or other audits.
Job Responsibilities (listed in order of importance and/or time spent)
Develops and executes internal monitoring and auditing activities in response to company risks in partnership with team members and leaders in other functional departments and geographic locations across Option Care; to include process documents, roll-out training and communications to launch audits, status updates to audit participants and relevant leaders, written report and presentation of findings, development and execution of corrective action plans and progress reports on responsive measures, and other associated activities as needed to successfully conclude audit and monitoring activities. Respects and maintains the confidentiality of sensitive business and patient information at all times. Maintains files and work papers consistent with Option Care policy and Compliance Department processes at all times.
Manages timely and accurate responses to payer audit requests processed by Compliance Audit Coordinators/Specialists (?); coordinates with Option Care locations and respective leadership for responsive information, review of findings and determination of appeal and appropriate corrective action; ensures corrective action implementation prevents repeat claim denials; creates and presents reports on payer audit findings to department and senior leadership.
Manages and partners with external consultants engaged to conduct compliance audits and related activities to support successful completion of such initiatives. Coordinates with external auditors and Option Care locations/departments under review to foster understanding and provide required documentation, correspondence, responses, appeal information or other necessary follow up as needed related to the audit process within deadlines.
Monitors payer audit activity internally reported in the Payer Audit database to ensure timely and responsive submissions; identify, track and report on payer audit trends; develop and execute responsive measures including training, policy and procedures or other actions as needed to demonstrate measurable improvement in audit outcomes.
Escalates and reports serious compliance, quality or other business risks timely to the Chief Compliance Officer and other functional leadership by demonstrating the ability to exercise good independent judgment in assessing the significance and relevance of identified issues.
Prepares clear, accurate and timely audit reports and ensure that audit work meets internal auditing standards.
Reports and presents major deficiencies and other findings to executive management, functional leaders and organizational committees.
Develops and implements action plans, follow up schedule and reports in coordination with respective department leads
Identifies policy, procedure, and process gaps and partners with functional leaders to develop responsive corrective measures to prevent reoccurrences.
Develops and revises compliance policy and procedures related to auditing and monitoring activities.
Assists with the development and implementation of compliance training programs.
Develops and manages strong working relationships with other team members and leaders within Option Care departments and locations.
Other duties as assigned to support Compliance Department and/or Option Care business.
Does this position have supervisory responsibilities?
(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)
Basic Education and/or Experience Requirements
Bachelor’s degree in business or a healthcare related field.
Certified Healthcare Compliance (CHC) or other related license/certification is preferred
Minimum of three years of compliance auditing in healthcare environment, preferably in home infusion/home health setting.
3-5 years experience directly managing people, including hiring, developing, motivating and directing people as they work.
Demonstrated effective communication, presentation, organizational, and writing skills with strong attention to detail Strong computer skills, including proficiency in Microsoft Office Suite applications
Working knowledge and understanding of federal and state healthcare regulations
Skilled in problem solving and critical analysis
Skilled in developing and delivering presentations
Travel Requirements: (if required)
Up to 25%
Preferred Qualifications & Interests (PQIs)
This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.
Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.