Compliance Manager

This is a fully remote position, open to applicants in California.

📋 Description

• Supervise compliance with the Company’s compliance program, utilizing the OIG Compliance Program Guidance for Third-Party Medical Billing Companies as a reference.

• Support the General Counsel in establishing a compliance committee and take the lead in conducting all committee meetings.

• Develop strategies to enhance efficiency and service quality while minimizing exposure to fraud, abuse, waste, and other risks.

• Investigate, assess, and address compliance-related issues, concerns, and complaints.

• Review publications from governmental health plans and organize training sessions on significant updates.

• Update the compliance program in response to the company’s needs and alterations in laws, policies, and procedures.

• Evaluate employee certifications to ensure comprehension of standards of conduct.

• Create, manage, and engage in compliance education and training initiatives.

• Coordinate the screening of personnel and providers against the Cumulative Sanction Report.

• Facilitate internal compliance audits and oversee departmental activities.

• Design and implement internal investigations along with corrective measures.

• Formulate policies that promote the reporting of suspected fraud and misconduct without fear of retaliation.

• Execute Medicare pre- and post-payment audits.

• Address patient complaints and disputes related to compliance or provider service issues.

• Research and devise solutions for coding and billing challenges.

• Establish and conduct internal reimbursement-coding audits, reporting findings on a bi-monthly basis.

• Monitor error rates to ensure improvement, or suggest additional actions as necessary.

• Provide relevant new and deleted CPT codes for updates to client fee schedules.

• Resolve coding issues in collaboration with business associates and internal staff.

• Communicate with payers to resolve prepayment review matters.

• Review accounts and manage the resolution of prepayment reviews.

• Deliver quarterly compliance training.

• Assist in training and troubleshooting issues related to payment deficiencies.

⛳️ Requirements

• Exceptional organizational abilities.

• Strong written and verbal communication skills.

• Proficient analytical skills.

• An undergraduate degree in a relevant field is preferred.

• Extensive understanding of ICD10-CM and CPT coding principles and guidelines.

• In-depth knowledge of federal regulations and policies related to physician documentation, coding, and billing.

• A minimum of 4 years of coding experience.

• At least 3 years of auditing experience.

• 1-2 years of supervisory experience.

• Ability to exercise judgment and recommend actions in situations where no precedents exist.

• Experience in medical billing and compliance within the healthcare sector is preferred.

• Oversee payer appeals specialists.

🏝️ Benefits

• Competitive salary.

• Comprehensive health benefits.

• Opportunities for professional development and advancement.

• Supportive work environment.