Vituity logo
Vituity

A physician-led-and-owned healthcare delivery organization, Vituity offers integrated, acute care expertise in the areas of anesthesiology, emergency medicine,

Manager, Compliance & Revenue Integrity

Location

United States

Posted

10 days ago

Salary

$85.2K - $106.5K / year

Seniority

Lead

No structured requirement data.

Job Description

Manager, Compliance & Revenue Integrity

Vituity

Role Description Provide ongoing advice, review, and resources for emerging risks in order to monitor compliance with state and federal requirements. - Manage and provide guidance on escalations from billing and coding teams, including responses to patient complaints, attorney inquiries, payor disputes, refund requests, and billing regulation changes. - Prepare and maintain reports for Vituity Compliance Program Leadership, Compliance Committee, senior leadership, and the Board of Directors. - Lead RCM Research Committee. - Develop and implement effective internal privacy and compliance controls to prevent and detect patterns of illegal, unethical, or improper conduct by MBSI employees, agents, affiliated providers, or other workforce members. - Maintain a current working knowledge of Federal and State regulations and policies as they affect operations through routine review of various manuals (CMS, Federal Register notices, Medicaid, etc.) and online resources. - Conduct or support routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits by external sources. - Develop and maintain positive rapport with outside agencies. - Assist in periodic reviews and revisions of enterprise and Compliance policies and procedures. - Identify compliance vulnerabilities and risks, and ensure that responses to reported concerns, alleged violations of law, and/or conflicts of interest are timely, appropriate, and consistent. - Prepare, maintain, and distribute various compliance reports. - Contribute to the annual Workplan and Risk Assessment process. - Support specialized compliance training throughout the organization (i.e. HIPAA, False Claims Act, Civil Monetary Penalties, Corporate Compliance/Ethics, etc.). - Perform regulatory research on industry topics and summarize information, including development of billing/coding compliance guides/manuals. - Perform other duties as assigned. - Conduct routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits generated by external sources (CMS). - Coordinate evaluations for measure-specific coding application and make recommendations, as needed. - Complete analysis and communicate trends in errors or documentation concerns to the Director of Coding Compliance & Revenue Integrity. - Participate in industry-related webinars and/or other conference calls, as needed, and summarize information for team and educational awareness messaging. - Offer recommendations for CMS programs enhancement. - Monitor activities of team members; provide feedback and counsel team members regarding performance. - Ensure compliance with local, state, and federal government requirements. - Assist with department tasks, as needed. - Facilitate and lead projects to monitor and audit the performance of the Compliance Program and related activities on a continuing basis in a collaborative and facilitative manner. - Manage incident tracking process including documenting investigations, overseeing corrective action plans, creating toolkits to use in analysis, and reporting outcomes. - Continually improve a centralized system for tracking incidents. - Manage the monthly review of OIG Workplan updates to ensure alignment. - Act as a steward by exhibiting sound ethical standards and consistently promoting a compliant culture. - Research and author educational materials. - Participate in Compliance Team Projects and initiatives when requested. - Develop expertise and perform research in compliance subjects and issues when requested. Qualifications - Bachelor’s degree in Business Administration, Healthcare, or related field desired. - Minimum 5+ years of health care compliance experience or equivalent field required. - Knowledge of and ability to apply Compliance policies, practices, systems, and standards required. - Experience in the application of CMS Quality Program measures highly desired. - Certified Procedural Coder (CPC certification, or equivalent, and/or Certification in Healthcare Compliance (CHC) preferred. - Ability to manage multiple tasks in a fast-paced, collaborative cross-functional environment. - Ability to remain organized and effectively manage competing priorities while meeting deadlines. - High attention to detail. - Ability to analyze new or ambiguous information, define the issue or problem, and project plan the resolution. - Ability to use analytical and creative problem-solving skills. - Ability to strike a balance between showing initiative and seeking appropriate guidance and input from others. - Excellent interpersonal skills, including conflict resolution. - Ability to effectively communicate orally and in writing. - Ability to use multiple Vituity systems and understand their connections and impact. - Advanced proficiency in Microsoft O365 (Word, Excel, Outlook, SharePoint, and PowerPoint). - Knowledge of Health Information Management principles, policies, and procedures. - Knowledge of compliance principles, including Office of Inspector General Seven Elements. - Knowledge of Healthcare systems, health plans, and/or physician groups. - Knowledge of pathology and etiology of disease, body areas, and organ systems. - Knowledge of CPT and ICD-10-CM coding practices and/or knowledge of Medicare/Medicaid billing practices and appeal process. - Knowledge of Health Insurance Portability & Accountability Act (HIPAA), Fraud Waste & Abuse, and Emergency Medical Treatment and Active Labor Act (EMTALA). - Knowledge of Medicare and Medicaid guidelines. Benefits - Superior health plan options. - Dental, Vision, HSA/FSA, Life and AD&D coverage, and more. - Top Tier 401(k) retirement savings plans that offers a $1.20 match for every dollar up to 6% plus discretionary profit-sharing contributions (eligible January following 18 months of service). - Generous paid time off starting 3-4 weeks annually. - Student Loan Refinancing Discounts. - Professional and Career Development Program. - EAP and travel assistance included. - Wellness program. - Purpose-driven culture focused on improving the lives of our patients, communities, and employees.

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