Orthotics and Prosthetics Billing and Compliance Lead

Why Join Michigan Medicine?

Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world?s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.

What Benefits can you Look Forward to?

• Excellent medical, dental and vision coverage effective on your very first day
• Generous PTO program
• State of the art technology and equipment
• 2:1 Match on retirement savings
  
  
  

Responsibilities*

O&P Billing and Compliance Lead is responsible for overseeing the billing and compliance for braces (DMEPOS) for Orthotics & Prosthetics. This entails ensuring adherence to insurance regulations and the functions/tasks (as outlined below).

• Provide training/education to the patient accounts/billing team and the providers/clinicians regarding billing/insurance rules/guidelines to ensure that the list of criteria for CMS LCDs are followed. Maintains current knowledge of changes in O&P national and local regulations/guidelines. Provides communication/education to staff regarding changes in policy and requirements to ensure proper documentation and regulatory compliance regarding O&P services. Provides assistance to all staff regarding compliance. Promotes compliance, best practices, and solutions. This requires continuous education and process monitoring for scheduling staff, front desk staff and the providers/clinical team.
• Performs audits to make sure new workflows are followed. Maintain workflows that remain compliant with O&P and CMS guidelines/regulations.
• Develop and manage the Billing & Compliance policy and procedure manual- Create resources and references for any policy/process changes.
• Stay apprised of policy changes, understand how they may impact the department, and advise leadership accordingly.
• Attend insurance education trainings and seminars to get up to date with changes.
• Modifier work queue - Review compliance to ensure modifiers are appropriate and documentation on file supports the claim for appropriate reimbursement- This may include other areas within the institution that dispenses a brace/orthotic.
• Oversee external regulatory payer audits (including Medicare) to ensure compliance including tracking, fulfillment and writing/completing appeals.
• Disseminate and review payer correspondences.
• Education for department on gaps to ensure compliance.
• Continuously work with Revenue Cycle Compliance & Provider Education in regard to audits and tracking.
• Manage and submit all Medicare audits in collaboration with Revenue Cycle Compliance & Provider Education.
• Develop and implement process improvement plan for audit resolution.
• Manage Medicare compliance (this includes internal auditing, education, and support) for orthotics dispensed at the below non-O&P ACUs including Medsport Cast Room, South
• Main Ortho, NHC Cast Room, BCSC Cast Room, Mott Cast Room and Taubman Cast Room.
• Responsible for the daily functional supervision of the billing & Compliance team- Total of 10 FTEs, (Senior Patient Account/Billing Reps- 7 FTEs, Financial Counselor- 1 FTE, 2 Billing & Compliance Specialists- 2 FTEs).
• Provide training and onboarding for new patient accounts/billing & compliance staff.
• Provide support and resolution for authorizations, billings, compliance, and patient financial counseling barriers.
• Communicate daily assigned work (authorizations & billings).
• Provide pending authorization, expired authorization and Medicaid eligibility reports.
• Manage pre-collection/pre-delivery verification process.
• Lead Bi-weekly billing and weekly compliance huddles.
• Communicate policy updates/changes and any other process/workflow changes.
• Manage all Chelsea Hospital deliveries to ensure billing compliance. Track and monitor for payment.
• Manage work queues and perform monthly write-off analysis, including tracking and follow-up. Research denials, provide necessary information to ensure proper payment, and provide follow-up.
  
  

Required Qualifications*

• Bachelor's degree
• 5 years of healthcare administrative support, with progressive responsibilities.
• Billing/patient accounts experience- strong knowledge of billing/compliance requirements and practices of various insurance carriers.
• Expertise in governmental/insurance regulations regarding O&P billing, documentation, and compliance.
• Ability to effectively lead a team, promoting best practices and teamwork to achieve organizational goals.
• Demonstrated skills/abilities regarding lean processes with proven outcomes.
• Strong analytic and problem-solving skills.
• Organized, highly motivated with a strong work ethic, demonstrated high level of responsibility and accountability.
• Ability to set priorities and manage competing deadlines.
• Strong and effective interpersonal (verbal and written) communication skills.
• Proficient in Microsoft Excel, Word, and Outlook
  
  
  

Desired Qualifications*

Familiarity with Epic and OPIE systems.

Work Locations

The University of Michigan Orthotics and Prosthetics Center is a large multi-disciplinary clinic dedicated to providing high quality orthotic, prosthetic, and pedorthic services for adults and children. The 30,000 square foot facility is located at 2850 S. Industrial Hwy, Ann Arbor, MI. The Orthotics and Prosthetics Center at Michigan Medicine is one of the few University based facilities in the country that offers comprehensive services and has been awarded the maximum three-year accreditation by the American Board for Certification in Orthotics, Prosthetics & Pedorthics.

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.