Compliance Claim Integrity Manager

Burrell Behavioral Health; Springfield (MO); On-site; USD 70,000 - 90,000; Full time

Job summary

Join a leading behavioral health provider as a Compliance Claim Integrity Manager in Springfield, Missouri. This pivotal role oversees healthcare compliance processes, ensuring integrity in billing and claims management. The ideal candidate will have strong analytical abilities and experience in healthcare auditing.

Benefits

Employee Assistance Program

Mileage Reimbursement

Employee Discounts

Workplace Culture Initiatives

Paid Time Off

Health, Dental, Vision Benefits

Career Advancement Opportunities

Qualifications

• Two years of healthcare auditing experience preferred.
• Must have a strong background in compliance and billing practices.
• Ability to oversee and analyze claim processes effectively.

Responsibilities

• Respond to overpayment reports and refund requests.
• Conduct investigations and prepare reports on findings.
• Coordinate with Compliance and Revenue Cycle teams for claims analysis.

Skills

Analytical Skills

Attention to Detail

Communication

Education

Associate's Degree in Health Information Management

Bachelor's Degree

RHIA or RHIT Certification

Job description

Job Description:

Job Title: Compliance Claim Integrity Manager

Location: Springfield, Missouri

Department: Compliance and Integrity

Employment Type: Full-time

Job Summary:
Join our dedicated team as a Compliance Claim Integrity Manager, where you will play a crucial role in ensuring the integrity of our healthcare compliance processes. You will collaborate closely with the Director of Compliance Risk Management to oversee investigations of potential overpayments, making a significant impact on our organization and the communities we serve. We are looking for someone with strong analytical skills, attention to detail, and the ability to communicate effectively with various stakeholders. Your expertise will help us maintain compliance and uphold the highest standards in healthcare billing practices.

In this role, you will respond to reports and refund requests from Federal health care program payors, conduct thorough investigations, analyze findings, and develop corrective actions. You will also prepare and present reports, maintain documentation, and coordinate with Compliance and Revenue Cycle teams, all while serving as a resource on coding and billing practices.

This position offers…
• Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Mileage Reimbursement – Company paid for work functions requiring travel
• Employee Discounts – Hotels, Theme Parks & Attractions, College Tuition
• Workplace Culture - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting a healthy, joyful workforce
• Additional Perks & Benefits - Scroll down to bottom of this post to learn more

Key Responsibilities:
• Respond to reports of potential overpayments and refund requests from Federal health care program payors.
• Investigate and analyze reported overpayments.
• Prepare and present reports on investigations and overpayments.
• Analyze claims data for trends and develop corrective actions.
• Maintain documentation of overpayments and repayments.
• Coordinate with Compliance and Revenue Cycle for claims analysis and repayment projects.
• Respond to inquiries on correct coding and billing practices.
• Supervise and train Compliance Claim Integrity Specialist.
• Verify consistency and accuracy of investigative analysis.
• Coordinate with Compliance Audit Team for probe audits.
• Stay current with Medicare guidelines and healthcare reimbursement laws.
• Facilitate other claims analysis activities as needed.
• All other duties as assigned.

Education, Experience, and/or Credential Qualifications:
• Associate's degree in Health Information Management required.
• Bachelor’s degree preferred.
• One of the following credentials (RHIA, RHIT) required .
• Two years of healthcare auditing experience highly preferred.

Additional Qualifications:
• Successful completion of background check including criminal record, driving record, abuse/neglect, and fingerprint check.
• Current driver’s license, acceptable driving record, and current auto insurance.

Physical Requirements:
• ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up to 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift .
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Keywords: Compliance, Integrity, Healthcare, Auditing, Overpayments, Claims Analysis, Medicare, Risk Management, Billing Practices, Documentation

Position Perks & Benefits:

Paid time off: full-time employees receive an attractive time off package to balance your work and personal life

Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more

Top-notch training: initial, ongoing, comprehensive, and supportive

Career mobility: advancement opportunities/promoting from within

Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness

Brightli is on a Mission:

A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.

As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.

We are an Equal Employment Opportunity Employer.

Brightli is a Smoke and Tobacco Free Workplace.