Medical Billing Compliance Manager

Job not on LinkedIn

🔥 4 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $110k - $125k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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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 • Assist the General Counsel in implementing and leading the Company’s compliance committee • Improve efficiency and quality of services 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 about relevant changes • Revise the compliance program in light of changes in company needs, laws, and payer policies • Review employee certifications and standards-of-conduct compliance • 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 possible compliance or provider service problems • Research and develop answers to coding or billing situations with the Vice President of Strategy and Integrity • Establish and perform internal reimbursement-coding audits • Report internal audit findings to leadership bi-monthly • Track error rates and ensure improvement or outline further steps • Provide pertinent new and deleted CPT code lists for client fee schedule updates • Troubleshoot coding issues for business associates and internal personnel • Communicate with payers regarding prepayment review resolution • Review accounts and determine resolution methods for prepayment reviews • Provide quarterly compliance training on new issues and identified deficiencies • Assist with training and troubleshooting for payment deficiencies • Manage payer appeals specialist

🎯 Requirements

• 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