Medical Records & Audit Manager

Company Overview Infusion For Health is dedicated to serving patients with autoimmune disorders and complex chronic conditions through exceptional infusion therapy. Our mission is to provide professional, compassionate, and patient-focused care in a welcoming environment, supported by a team of highly trained clinical and administrative professionals. Position Summary The Medical Records & Audit Manager is responsible for overseeing the release of information process and ensuring timely, compliant responses to medical record requests from payers, attorneys, regulatory agencies, and patients. The role also manages and coordinates payer and regulatory audits, tracks all audit activity, identifies patterns of risk, and reports findings to leadership. This position ensures compliance with HIPAA, HITECH, CMS, state regulations, and payer contractual requirements, while supporting organizational integrity and revenue protection.

Key Responsibilities

Medical Records Management & Release of Information

• Oversee the intake, processing, and fulfillment of medical record requests from payers, attorneys, patients, and government agencies.
• Ensure all RELEASE OF INFORMATION activities comply with HIPAA Privacy Rule, HITECH, and state-specific requirements.
• Establish turnaround standards for responses and monitor timeliness and accuracy.
• Collaborate with legal and compliance teams on subpoenas, court orders, and sensitive requests.
• Implement procedures to safeguard patient privacy and minimize organizational risk.

Audit Management

• Coordinate and manage payer audits, RAC/MAC/ZPIC/UPIC reviews, state Medicaid audits, and commercial payer reviews.
• Serve as the primary contact for auditors, ensuring appropriate documentation is gathered and submitted timely.
• Oversee internal preparation for audits, including pulling records, validating accuracy, and coordinating with revenue cycle and clinical teams.
• Manage appeals for adverse audit findings in collaboration with compliance, legal, and revenue cycle leaders.
• Ensure consistency in organizational responses to audits, reducing risk of denials or penalties.

Tracking & Reporting

• Maintain a centralized log of all medical record requests and audit activity.
• Track audit outcomes, denial rates, appeal statuses, and recovery amounts.
• Analyze data to identify trends in audit activity and potential areas of risk (e.g., coding, documentation, billing).
• Develop and present regular audit reports and risk summaries to Compliance Committee, Revenue Integrity, and Executive Leadership.

Leadership & Oversight

• Supervise staff responsible for medical record fulfillment and audit coordination.
• Provide training on compliant RELEASE OF INFORMATION processes and audit preparation.
• Develop and update policies and procedures related to RELEASE OF INFORMATION and audit management.
• Collaborate with Coding, Billing, Compliance, Legal, and Clinical teams to address risk areas identified in audits.

Qualifications

Education & Experience

• Bachelor’s degree in Health Information Management, Healthcare Administration, Compliance, or related field (Master’s preferred) or equivalent experience.
• 5+ years of HIM, compliance, or audit experience.
• Experience managing payer audits (RAC, MAC, commercial payer, etc.) and RELEASE OF INFORMATION processes.

Knowledge, Skills, and Abilities

• Strong knowledge of HIPAA, HITECH, CMS regulations, payer audit protocols, and medical record retention laws.
• Ability to interpret payer policies, government audit findings, and legal requirements.
• Excellent organizational skills with attention to detail and ability to manage multiple deadlines.
• Strong communication skills, with ability to interact effectively with payers, attorneys, providers, and leadership.
• Data analysis and reporting skills, with ability to identify patterns and recommend corrective action.

Join our dedicated team at Infusion For Health and help us make a meaningful difference in patients' lives by ensuring their medical information is managed with precision and care. Your expertise can elevate our standards of excellence—apply today to become a vital part of our mission. Job Type: Full-time Pay: $70,000.00 - $85,000.00 per year Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Education:

• Bachelor's (Required)

Experience:

• HIM, compliance, or audit: 5 years (Required)
• managing payer audits: 5 years (Required)
• interpret payer policies: 5 years (Required)
• interpretting government audit findings: 5 years (Required)

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