Compliance Manager

🔥 3 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $110k - $125k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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Brault

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1990

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Data Analytics

Brault is a company specializing in End-to-End Revenue Cycle Management (RCM) and practice management services tailored for healthcare providers, particularly in acute care settings. With over 25 years of experience, Brault offers customized solutions in areas such as coding and billing, provider education, practice analytics, and operational support to help physician groups and hospitals navigate the complexities of healthcare management. Led by Dr. Andrea Brault and a team of experts, the company is dedicated to enhancing the efficiency and effectiveness of healthcare practices nationwide.

📋 Description

• 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

🎯 Requirements

• 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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