Overview of Role
Penstock is searching for an Audit Program Operations Manager who will be working in a fast-paced, results-driven environment. Reporting to the Vice President, Operations, the Audit Program Operations Manager will assist the VP in the development and oversight of all payment integrity and regulatory compliance initiatives.
The Audit Program Operations Manager responsibilities will include, but are not limited to, the following:
- Evaluates complex project requirements and translates them into actionable deliverables.
- Demonstrates mastery of a wide application of professional principles, theories, and concepts. Troubleshoots and provides solutions for unusually complex problems.
- Identifies, tracks, monitors, and communicates project‐related issues, scope changes, variances, and contingencies that may arise. Escalate issues to leadership as needed. Employs issue and risk mitigation strategies.
- Monitors and reports production-related activities for all revenue-producing initiatives.
- Generates short and long-term reports for department and Penstock leadership as needed.
- Ensures that staff has the proper materials, systems access, and training to complete job responsibilities. Provides oversight for the execution of the training plan, SOW review and training experiences, as applicable.
- Participates in the selection for hiring new employees by conducting candidate review and participating in the interviewing process. Ensures that new employees are properly onboarded and trained.
- Plans and develops presentation materials for periodic management review of key performance indicators.
- Attends and/or leads meetings (webinars, trainings, workshops).
- Contributes to the productivity of the organization through the completion of projects associated with departmental objectives.
- May be a primary point of contact with vendors and consultants engaged in supporting the work activities of the group.
- Bachelor’s degree or relevant experience required
- Coding Certification:
- RHIA or RHIT
- Inpatient Coding Credential – CCS or CIC preferred
- Candidates who hold a CCDS or CPC will be given consideration but will need to obtain an inpatient coding certification within 1 year of their hire date with the company.
- Experience (required)
- 7 to 10+ years of working with ICD-9/10CM, MS-DRG, AP-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria, and coding terminology.
- Adherence to official coding guidelines, coding clinic determinations, and CMS and other regulatory compliance guidelines and mandates. Requires expert coding knowledge – DRG & ICD-10.
- Requires working knowledge of applicable industry-based standards.
- Proficiency in Word, Access, Excel, and other applications.
- Excellent written and verbal communication skills.
- Self-starter with a strong sense of ownership and orientation towards technical details
- Creative thinker with bias for action
- Strong oral and written communication skills, including presentation skills
- Strong problem solving and troubleshooting skills with the ability to exercise mature judgment
- Trending, forecasting, or predictive modeling