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   Current UPMC employees must apply in HR Direct

Manager, Compliance Review

  • Job ID: 46584044
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Finance
  • Department: Corporate Compliance
  • Location: 3600 Forbes Ave, Pittsburgh PA 15213
  • Union Position: No
  • Salary Range: $29.80 to $50.31 / hour

Description

As the Manager, Compliance Review you will be responsible for assisting with the development of compliance programs, and related educational and training materials throughout UPMC under the direction of the Director of Corporate Compliance. Provide for assisting with all compliance related activities, including physician reviews and outside agency audits, working collaboratively with the UPMC Compliance and Privacy Offices, Patient Business Service, Corporate Legal and Internal Audit departments as necessary. Provide vision in planning by setting measurable goals, establishing a monitoring and reporting process regarding all ongoing compliance and ethics activities under the direction of the Director of Corporate Compliance. Interact with all UPMC business units at all levels of the organization.

Responsibilities:
  • Manage and coordinate the staff and related activities in order to achieve compliance with government and regulatory established deadlines.
  • Assists in developing compliance training materials and performs ongoing compliance training.
  • Performing or assisting in 'special audits and reviews as defined by requests from inside departments and outside agencies.
  • Participate in the resolution and the communication of various ComplianceAskUs questions or inquiries.
  • Manage the process, and related staff, for the routine physician review and audit to ensure compliance with Federal, State and Payor regulations and guidelines in accordance with UPMC policies and timeframes.
  • Assist with establishing policies and procedures in support of compliance and ethics activities.
  • Maintain a working knowledge of various laws, regulations and industry guidance that impact the corporate compliance program.
  • Acts as a resource and provides guidance to staff, administrators, and providers regarding compliance issues and process improvement.

Qualifications

  • Bachelor Degree preferred or Associates Degree with Professional Coding Certification Required. 
  • Minimum of 5 years work experience with related activities in management and compliance such as Regulatory Review, Medical Records, Registration, Billing and Reporting required. 
  • Knowledge of Microsoft Office applications is required along with well-developed analytical, problem-solving and interpersonal skills. 
  • Require to demonstrate professionalism, political astuteness, diplomacy, the ability to work collaboratively with others. 
  • Require the ability to exercise extreme tact and good judgment.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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