Billing & Compliance Audit Manager

Billing Compliance and Audit Manager is responsible for the identification, development and delivery of new and ongoing provider education and training related to coding and clinical documentation. In addition, the role conducts independent and collaborative audits according to the compliance work plan and develops appropriate documentation to support audit work performed; and performs other related duties as assigned.

RESPONSIBILITIES

Job Specific Competencies:

Responsible for all aspects of the coding and compliance education and audits of the providers and the coders.

Solid analytical skills with the ability to look at the big picture impact and work on project management.

Will work independently and use critical thinking skills to problem solve.

Uses excellent written and verbal communication skills. Ability to express complex issues and situations in clear and understandable terms. Can understand and carry out oral and written instructions and to request clarification when needed.

Billing Compliance and Audit Manager will audit both outpatient and inpatient medical records to verify the appropriateness of diagnostic codes and medical record abstracts.

Work with physicians and administration, and the revenue cycle team to ensure complete and accurate information and optimal reimbursement based on coding and abstracting of medical records.

Provide excellent public relations and courteous customer service; establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, contractors and other health care personnel.

Respond with flexibility and efficiency to frequent changes in task focus, competing priorities, and multiple deadlines.

Prepares reports, letters, instructions, emails, and other documents with attention to clarity, tone, composition, and mechanics.

Aids in the implementation of new billing requirements mandated by the insurance companies or government.

Aid in the setup of new clinics, new entities, new providers, new services for the billing process, including documentation and implementation of the process to ensure goals are met.

Aid in developing and implementing new procedures to improve the quality and quantity of work processed. Ensures procedures are documented, communicated, and administered consistently.

Leads proactively and is a visionary who influences, mentors and holds staff accountable.

Maintain and enforce confidentiality of sensitive information.

Analyze problems, perform research, formulate logical conclusions and/or alternatives, make recommendations, and implement solutions.

JCMG Core Competencies:

Strives for continuous quality improvement.

Participates in educational experiences designed to maintain and/or improve professional competence.

Maintains high work ethic standards.

Provides quality customer service to staff, patients and visitors at all times.

MINIMUM QUALIFICATIONS

Education:

A minimum of an Associate Degree in related concentration such as Health Information

Experience:

Minimum five (5) years of experience in healthcare professional billing, coding, and audit.

Minimum three (3) years of management experience

Certification/License:

Billing Compliance and Audit Manager should be a Certified Professional Coder Certificate (CPC)

Certified Evaluation and Management Coder (CEMC)

Knowledge/Skills/Abilities:

Principles and practices of healthcare administration; principles and practices of leadership and supervision; principles of work planning and organization.

Advanced principles and practices of medical record keeping; advanced medical terminology, anatomy, and physiology, as well as the states, sequence, progression and description of diseases as they apply to medical record coding and abstraction.

Current healthcare reimbursement systems and associated regulatory review practices.

Appropriate methods for auditing and reviewing information for quality control purposes.

The operation of standard office equipment; standard business computer hardware and software.

The business and professional relationships and ethics involved among hospitals, physicians and patients.

A wide degree of creativity and latitude is expected.

Proficient use and extensive working knowledge of billing procedures, application and use of ICD-9- CD-10, CPT and modifiers using professional coding guidelines consistent with Federal Regulations.

Acts with confidence, builds credibility and trust.

BENEFITS

Health insurance & employer paid short- and long-term disability

Generous PTO policy, beginning at 148-hours annually

56 hours paid Holiday Leave

Employer Retirement Plan (401K) with employer match

Tuition reimbursement and other professional advancements, including a Medical Assistant training program

Pay Range: $64,781.63 - $79,357.50 per year