Compliance Program Manager

2 days ago

Anchorage, Alaska, United States LifeMed Alaska LLC Full time
Job Summary

We are seeking a highly skilled Compliance Program Manager to join our team at LifeMed Alaska LLC. The successful candidate will be responsible for ensuring that our organization adheres to all applicable state and federal laws and regulations related to EMS charting and billing practices.

Key Responsibilities
  1. Develop and Implement Compliance Programs: Design, implement, and monitor LifeMed's billing compliance program, providing periodic reviews and updates as needed to ensure compliance with changing regulations.
  2. Collaborate with Education Team: Work alongside the education team to organize and conduct necessary industry training for appropriate personnel on HIPAA, CMS requirements, and other relevant topics.
  3. Investigate and Resolve Compliance Concerns: Act as the point of contact and work with the billing partner to investigate and resolve internal and external reports of billing and regulatory compliance concerns.
  4. Communicate Compliance Updates: Maintain regulatory review and communicate to staff and the billing agency any compliance updates and requirements.
  5. Monitor Adherence to Regulations: Monitor adherence with all applicable regulations, policies, and procedures, and identify potential vulnerability and risk areas, including audits of medical records and documentation to ensure accuracy, medical necessity, and regulatory review as appropriate.
  6. Investigate Patient Complaints: Investigate patient complaints, issues, and concerns and provide recommendations for corrective action.
  7. Identify Compliance Vulnerabilities: Identify potential areas of compliance vulnerability and risk and communicate recommendations for improvement to appropriate stakeholders.
  8. Develop Reports and Guidelines: Create and maintain reports, guidelines, and training materials for medical documentation best practices.
  9. Assist Finance Team: Assist the finance team and outside billing agency with financial data and patient account inquiries.
Requirements
  • Strong Communication and Customer Service Skills: Possess excellent communication and customer service skills to effectively interact with staff, stakeholders, and external partners.
  • Ability to Work Independently: Demonstrate the ability to work independently and be a self-starter, with a strong sense of initiative and problem-solving skills.
  • Policy Development and Experience: Possess experience in policy development and writing standard operating procedures, with a strong understanding of regulatory requirements.
  • Critical Thinking and Collaboration: Demonstrate strong critical thinking skills, with the ability to handle complex situations and provide solutions, as well as excellent collaboration skills to work effectively within a team.
  • Industry Knowledge and Experience: Possess knowledge of ambulatory and EMS industry documentation, including billing practices and requirements, as well as experience in mobile technologies and computer networking systems, including electronic medical information.
  • Working Knowledge of MS Office: Possess a working knowledge of MS Office, with strong computer skills and the ability to learn new software applications quickly.
  • Knowledge of Medicaid, Medicare, and Other Regulations: Possess knowledge of Medicaid, Medicare, Managed Care, Private Insurance, Auto Insurance, and IHS regulations and requirements, as well as industry knowledge and understanding of requirements under OIG to comply with CMS, HIPAA, EMTALA, and STARK laws.
Essential Job Qualifications
  • Certification from a Professional Organization: Possess certification from a professional organization, such as AAHAM, HFMA, AAPC, or NAAC, with a preference for those holding ambulance-specific certifications.
  • Experience in Billing and Management: Possess 5+ years of billing experience, with a preference for transport billing, and 3+ years of management experience, with a strong understanding of medical records and electronic information systems.
  • Skills and Qualifications: Possess strong skills in Microsoft 365, with an emphasis on Microsoft Excel, including building formulas, workbooks, and pivot table functions, as well as experience in accounts payable and accounts receivable duties, with data input.
Other Qualifications
  • Ability to Read and Analyze Policy Manuals: Possess the ability to read, analyze, and interpret policy and procedure manuals, as well as technical procedures.
  • Ability to Write Reports and Correspondence: Possess the ability to write reports and business correspondence, as well as effectively present information and respond to questions from groups of managers, customers, and other employees.
  • Ability to Define Problems and Solve: Possess the ability to define problems, collect data, establish facts, and draw valid conclusions, as well as solve practical problems and deal with a variety of variables in situations where only limited standardization exists.

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