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Billing Compliance Program Manager

2 months ago

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

We are seeking a highly skilled Billing Compliance Program Manager to join our team at LifeMed Alaska LLC. As a key member of our organization, you will be responsible for ensuring compliance with all applicable state and federal laws and regulations related to EMS charting and billing practices.

Key Responsibilities
  • Develop, implement, and monitor LifeMed's billing compliance program, providing periodic reviews and updates as needed as regulations change.
  • Work alongside the education team to organize and conduct necessary industry training for appropriate personnel (HIPAA, CMS requirements).
  • 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.
  • Maintain regulatory review and communicate to staff and billing agency any compliance updates and requirements.
  • Monitor adherence with all applicable regulations, policies, and procedures and identify potential vulnerability and risk areas to include audits of medical records and documentation to ensure accuracy, medical necessity, and regulatory review as appropriate.
  • Investigate patient complaints, issues, and concerns and provide recommendations for corrective action.
  • Identify potential areas of compliance vulnerability and risk and communicate recommendations for improvement to appropriate stakeholders.
  • Create and maintain reports, guidelines, and training materials for medical documentation best practices.
  • Assist the finance team and outside billing agency with financial data and patient account inquiries.
Requirements
  • Must possess required knowledge, skills, abilities, and experience and be able to explain and demonstrate, with or without reasonable accommodation, that the essential functions of the job can be performed.
  • Strong communication and customer service skills.
  • Ability to work independently and be a self-starter.
  • Policy development and experience in writing standard operating procedures.
  • Critical thinking – able to handle complex situations and provide solutions.
  • Strong collaboration skills and ability to work within a team.
  • Knowledge of ambulatory and EMS industry documentation, to include billing practices and requirements. Background in mobile technologies and computer networking systems, including electronic medical information required.
  • Working knowledge of MS Office (strong computer skills).
  • Knowledge of Medicaid, Medicare, Managed Care, Private Insurance, Auto Insurance, and IHS regulations and requirements.
  • Knowledge of EMS industry charting and billing practices.
  • Industry knowledge and understanding of requirements under OIG to comply with CMS, HIPAA, EMTALA, and STARK laws.
Essential Job Qualifications
  • (Any equivalent combination of knowledge, skills, abilities, education, and experience)
  • Licensure: Certification from a professional organization (AAHAM, HFMA, AAPC, NAAC, etc.). Preference will be given to those holding ambulance-specific certifications. Obtain Certified Ambulance Compliance Officer (CACO) and Certified Ambulance Coder (CAC) designations within one year of appointment to this position and maintain current licensure.
  • Experience: 5+ years billing experience is required. Transport billing is preferred. 3+ years management experience is required. Must have knowledge of medical records and electronic information systems.
  • Skills and Qualifications: Microsoft 365 with emphasis on Microsoft Excel, including building formulas, workbooks, pivot table functions. Experience in accounts payable (A/P) and accounts receivable (A/R) duties with data input. Experience of working directly in an accounting role with responsibility for keeping and maintaining records, entering journal entries, and reporting.
  • Other Qualifications: Ability to read, analyze, and interpret policy and procedure manuals, and technical procedures. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, customers, and other employees. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Ability to interpret a variety of instructions and apply them to the situation.
Attendance and Language Requirements
  • Regular attendance is required for this position.
  • English Language: Must be able to read, write, and speak English.