Billing and Clinical Compliance Manager

Position Summary

Oversees audit and education activity for clinical services in accordance with the Professional Compliance Plan. Ensures accurate and complete documentation, real-time monitoring, regulatory based education, and corrective action plans for all surgical programs.

Job Responsibilities

• Monitors auditing and medical record documentation compliance with federal and state regulations. Educates clinical staff, department staff, and providers on compliant documentation.
• Provides guidance and tools to assist departments improve compliance metrics. Partners with department compliance liaisons to develop monitoring programs.
• Conducts prospective and retrospective compliance documentation audits. Designs tools and methodology for conducting audits. Tracks and trends results of audits. Prepares and presents reports on audit results.
• Reviews surgical complaints / incidents and designs scope of audits; identifies resources needed to determine compliance.
• Serves as a resource to clinical departments on coding, documentation and regulatory guidelines.
• Responsible for designing and conducting focused new provider education programs that is specific to each new provider.
• Develops, prepares and presents reports and compliance metrics.
• Performs routine and special compliance audit and monitoring as deemed necessary, including but not limited to, the management sanction screening, OMIG, CMS, and OIG compliance, and payer compliance.
• Assists the Chief

Salary : $110,500 - $124,100