Compliance Pre-Billing Manager - Charter Healthcare

POSITION SUMMARY: The Compliance Pre-Billing Manager: Responsible for the planning, designing, implementing, and maintaining Medicare/Medi-cal and other payors, Joint Commission of Healthcare Organizations (JCAHO)/CHAP wide compliance and audit programs, policies, and procedures that promote a corporate culture that fosters ethical and compliant behavior and provides the basis for ensuring adequate internal controls and compliance with all laws and regulatory requirements applicable to all payors and accreditations.

REPORTS TO: VP of Regulatory Compliance

SUPERVISES: Pre-Billing Team

QUALIFICATIONS:

Education: Bachelor’s degree is required. Master’s or Juris Doctorate degree is preferred.

Healthcare Compliance Certification required or within 6 months of assuming job.

Experience: A minimum of 5 years’ experience in a healthcare organization, to include demonstrated leadership. Familiarity with COPs, LCDs, NCDs and state regulatory guidelines for all Charter service lines is a must.

Core Competencies: Compliance, legal, or audit experience within a healthcare company, experience monitoring reports and interpreting data, interpersonal skills to interface with various business units, strong attention to detail and project management skills. Strong organizational skills and an orientation to deadlines and detail. Ability to respond well under pressure. Skills in use of information systems, databases, Excel and Microsoft Word. Well-developed communication skills. Diligent about follow-through, thorough and well-prepared.

Other: Valid driver’s license and auto insurance.

FUNCTIONS AND RESPONSIBILITIES:

1. Provide oversight and management of all billing audits.

2. Oversight and tracking of all agencies pre-billed claims and maintain comprehensive information on the billing status and communication with the billing department.

3. Facilitates the organization and reviews medical records and billing/claim information for each claim requested for Additional Documentation Review or other medical records requests.

4. Monitors and analyzes trends in disallowed claims and prepares reports as requested for agency leadership with additional training provided as needed.

5. Implement and maintain a system of management reporting that provides timely and relevant information on all aspects of audit and compliance issues.

6. Develops and ensures efficient processes for documenting all compliance-related initiatives and activities.

7. Establish audit controls and procedures to monitor operational effectiveness and fiscal integrity.

8. Provide guidance to management, medical staff, and individual departments so that clinical and other ancillary staff are aware of their responsibility for ensuring compliance with those areas.

9. Foster open lines of communication and exercise authority to apprise department heads of any issues of concerns relating to compliance activities and procedures.

10. Monitor and analyze trends in disallowed claims and prepare reports as requested for agency leadership with additional training provided as needed.

11. Monitors CMS, FI, MAC, state, and local guidelines to determine changes to documentation and billing requirements.

12. Develops and ensures efficient processes for documenting all compliance-related initiatives and activities.

13. Develop and recommend annual compliance and internal Quality Assurance (QA) audit programs and reports conclusion and recommendations to QA committee and Board of Trustees.

14. Develop policies and procedures that set up standards for internal audit and compliance, giving specific guidance to management, medical staff, and individual department as appropriate.

15. Direct efforts to communicate compliance initiatives including written materials and training programs designed specifically to promote awareness and understanding of compliance issues.

16. Reviews complaints, concerns, or questions related to compliance issues and provide consultative leadership and support as necessary.

17. Support and participate in all quality improvement initiatives.

18. All other duties and responsibilities as assigned.