Healthcare Compliance Manager

2 weeks ago

Plymouth, United States Ophthalmic Consultants of Boston Full time
Job DescriptionJob Description

OCB is currently seeking a Healthcare Compliance Manager. They will be based out of our Plymouth office and travel to other offices as necessary. The ideal candidate will have prior clinical experience, successfully worked across all levels of an Ophthalmic, sub-specialty or general medical practice, with significant experience and exposure to compliance, billing, and coding practices.  Understands, practices, and maintains superior diplomacy, conflict resolution, and problem-solving skills.  He/she is exceptionally detailed oriented and has demonstrated the ability to educate and manage employees at all levels of an organization.  

Position Overview:

This “hands-on” role is responsible for designing, developing, implementing, supervising, and reviewing internal policies, procedures, processes, and practices to assure all patient coding and documentation is accurately interpreted, captured, and managed in accordance with regulatory and Practice requirements.  Works across the practice and entities with providers, clinical managers, technicians, scribes, and billing personnel to educate, train, audit, research, investigate, problem solve and resolve compliance related requirements and issues; mitigating risks and reinforcing required practices to assure best practices are implemented and maintained throughout the Practice and its affiliates.

Responsibilities include:

  • Maintains an in-depth and ongoing understanding of industry related compliance requirements, issues, coding updates, regulatory changes, and industry related best practices.
  • Assures OCB’s Compliance Program is aligned with regulatory and Practice requirements by developing, implementing, monitoring, and maintaining policies, procedures, and programs to support ongoing activities and requirements of compliance program. 
  • Coordinates and delivers educational training programs consisting of appropriate documentation guidelines, and accurate coding to all appropriate personnel including coding staff, scribes, clinical managers and technicians, physicians/providers, and billing personnel.
  • Perform internal audits and compliance reviews, identifying, escalating, resolving, and managing requirements and issues in timely and proactive manner.
  • Conduct regular coding audits and coordinate the monitoring of coding and documentation accuracy, reviewing claim denials and rejections pertaining to coding and medical necessity issues. 
  • Proactively identifies less-apparent coding issues and red flags, by monitoring data, reporting, and procedures/practices to anticipate the obvious and most complex of coding issues; continuously mitigating risks by escalating as needed and recommending remedies.
  • Collect, analyze, interpret, and document information to support audit findings, present to all levels of management and providers regarding findings and recommendations.
  • When necessary, assist in the implementation of corrective action plans, such as educational programs to prevent similar denials and rejections from recurring.
  • Receive, investigate, and report on compliance complaints and “hotline” reports.
  • Evaluate adequacy of managements and providers response to recommendations cited, provide feedback and reporting as needed and required.
  • Conduct annual audits as it relates to regulatory agencies assuring adherence to regulatory requirements.
  • Report non-compliance issues detected through auditing and monitoring, create corrective action plans and results of follow-up audits to the  VP of Operations and Senior Management.
  • Maintain ongoing knowledge of coding, regulations, and compliance/regulatory agencies.
  • Serves as patient advocate, addressing and managing escalated patient concerns.
  • Provide research and support for special projects.

Education, Experience and Skills:

  • Minimum of five to seven years of physician billing/auditing experience. Experience as a clinical technician in ophthalmology practice preferred.
  • Extensive knowledge of CPT coding principles, guidelines and practices is required.
  • Experience with performing physician compliance reviews of healthcare institutions especially subspecialties, ideally in an ophthalmic setting.
  • Strong knowledge base in complete and accurate clinical documentation
  • Knowledge of electronic medical records and practice management software
  • Minimum of 5 years of medical auditing in a health care setting, progressive experience in out-patient coding and billing preferred.
  • Strong knowledge of Federal (HIPPA) and State health care regulations, standards, policies and requirements pertaining to documentation, coding and billing.
  • The ability to accurately interpret and implement regulatory standards and legal requirements
  • Strong analytical and problem-solving skills and proficient in report writing and oral communications
  • Ability to influence, push-back and hold accountable in a professional and diplomatic manner.
  • Strong professional attitude and demonstrated ability to communicate effectively with all levels of management and personnel.
  • Highly organized with ability to multi-task and prioritize
  • Ability to establish and maintain effective working relationships with patients and staff members.
  • Strong computer skills
  • Bachelor’s degree, or equivalent experience.  Masters preferred.
  • Ability to travel to various offices

Benefits Offered:
  • Health & Dental Insurance- eligible 1st day of employment
  • Paid time off and paid holidays
  • Health & Dependent Reimbursement Accounts
  • 401(k) Plan with company contribution
  • Company paid Life and LTD Insurance
  • Employee discounts

To find out more about OCB, please visit our website at www.eyeboston.com. OCB is an Equal Opportunity Employer

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