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Manager, Compliance and Coding Audit

Location US-TX-Addison
ID
328009
Pos. Category
Corporate - Other
Pos. Type
Full Time

Overview

The Manager, Compliance & Coding will function in a support role for the VP, Privacy & Compliance Officer to help ensure consistent organizational adherence with established billing, coding, and regulatory compliance requirements, Develop, review, and interpret applicable policies and procedures and ensure their accurate dissemination throughout the company. Works with the clinical leadership to monitor/audit company’s billing and coding processes. Responsible for completing periodic audit and monitoring functions, conducting appropriate research, initiating investigations if needed, and preparation of audit results. The Manager, Compliance & Coding Audit will provide guidance and education to clinicians and/or operations regarding compliance topics, documentation, and coding practices; and assist with handling escalated or otherwise designated compliance matters as necessary.

Responsibilities

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Manage activities related to the development, implementation, and execution of Concentra’s Billing & Coding Audit process.
 
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Serve as a documentation and coding leadership resource for those with questions or concerns.
 
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Work with clinical leadership to develop coding and documentation guidelines.
 
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Remain informed of regulatory developments including changes to documentation and coding rules and manage the implementation of changes in policies and procedures in response to such developments.
 
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Receive, investigate, and track non-privacy related compliance issues.
 
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Participate on ad hoc and regular committee meetings for the organization as a Compliance Department representative.
 
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Maintain and requires strictest confidentiality.
 
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Work effectively with government agencies, clients and internal contacts to resolve regulatory and business issues.
 
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Review rules and identify procedural changes/variances required to ensure compliance.
 

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications

Education Details:
 
 
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Some college courses from an accredited college or university or equivalent education and experience
 
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In lieu of higher education, the ratio is 1:1 meaning one year of college equals one year of work experience and vice versa
 
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Bachelor's degree preferred
 
Certifications and/or Licenses:
 
 
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HCCA or AAPC certification highly preferred.
Customarily has at least the following experience:
 
5 years
 
 
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Customarily has at least five (5) years of progressive experience in health care compliance and auditing to include healthcare billing and coding.
 
Job-Related Skills/Competencies
 
 

• Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility

• Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions

• Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism

• The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies

 
 
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Knowledge of HIPAA (Health Insurance Portability & Accountability Act), CMS (Center for Medicare and Medicaid Services), DOT (Department of Transportation), Medical Coding auditing, OSHA (Occupational Safety and Health Act), and (WC) Workers Compensation regulations.
 
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Excellent professional communication skills and ability to work productively with employees at all levels of the organization.
 
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Superior organizational skills and conscientious attention to detail.
 
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Ability to handle confidential information with maturity and discretion.
 
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Ability to work independently and as part of a working group.
 
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Possess excellent time management skills with ability to prioritize tasks.
 
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Ability to evaluate risk level and escalate matter to leadership when necessary for additional review/feedback.
 
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Have proven analytical and problem-solving skills.

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