Compliance Manager

🔥 7 horas atrás

🏄 California – Remoto

🏄 California – Remote

💵 $110.000 - $125.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🚔 Conformidade

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Brault

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1990

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance • Data Analytics

Brault é uma empresa especializada em Gestão do Ciclo de Receita de ponta a ponta (RCM) e serviços de gestão prática personalizados para provedores de saúde, especialmente em ambientes de cuidados agudos. Com mais de 25 anos de experiência, a Brault oferece soluções personalizadas em áreas como codificação e faturamento, educação de provedores, análise de práticas e suporte operacional para ajudar grupos de médicos e hospitais a navegar pelas complexidades da gestão de saúde. Liderada pela Dra. Andrea Brault e uma equipe de especialistas, a empresa se dedica a aprimorar a eficiência e eficácia das práticas de saúde em todo o país.

Descrição

• Oversee adherence to the Company’s compliance program using OIG Compliance Program Guidance for Third-Party Medical Billing Companies as a guide • Assist the General Counsel in implementing a compliance committee and lead and conduct all meetings • Establish methods to improve efficiency and service quality and reduce vulnerability to fraud, abuse, waste, and other risks • Investigate, review, and respond to compliance issues, concerns, and complaints • Review governmental health plan publications and arrange training on relevant changes • Revise the compliance program based on company needs and changes in laws, policies, and procedures • Review employee certifications and ensure understanding of standards of conduct • Develop, coordinate, and participate in compliance education and training programs • Coordinate personnel and provider screening against the Cumulative Sanction Report • Coordinate internal compliance reviews and monitor departmental activities • Design and coordinate internal investigations and corrective actions • Develop policies encouraging reporting of suspected fraud and improprieties without retaliation • Process Medicare pre- and post-payment audits • Process patient complaints and disputes involving compliance or provider service problems • Research and develop solutions for coding and billing situations • Establish and perform internal reimbursement-coding audits and report findings bi-monthly • Track error rates and ensure improvement or recommend further steps • Provide pertinent new and deleted CPT codes for client fee schedule updates • Troubleshoot coding issues with business associates and internal personnel • Communicate with payers regarding prepayment review resolution • Review accounts and coordinate resolution of prepayment reviews • Provide quarterly compliance training • Assist with training and troubleshooting for payment deficiencies

🎯 Requisitos

• Excellent organizational skills • Excellent written and oral communication skills • Excellent analytical skills • Undergraduate degree in related field preferred • Extensive knowledge of ICD10-CM and CPT coding principles and guidelines • Extensive knowledge of federal regulations and policies pertaining to physician documentation, coding, and billing • 4+ years coding experience • 3+ years auditing experience • 1-2 years supervisory experience • Ability to exercise judgment and propose courses of action where precedent may not exist • Experience in medical billing and compliance in healthcare preferred • Manages payer appeals specialist

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