Healthcare Billing Compliance Lead

RiseMe; San Dimas (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

RiseMe is seeking a Compliance Manager to assure that the Company and all stakeholders adhere to the letter and spirit of applicable government laws, regulations, policy and procedures.

You will oversee the compliance program, lead the compliance committee, train staff, investigate issues, and coordinate internal reviews with various departments to reduce risk and ensure accurate coding, billing, and reporting.

Qualifications

• Undergraduate degree in related field preferred.
• Extensive knowledge of ICD10-CM and CPT coding principles and guidelines.
• Extensive knowledge of federal regulations and policies pertaining to physician documentation, coding, and billing.
• 4+ years coding experience.
• 3+ years auditing experience.
• 1-2 years supervisory experience.
• Experience in medical billing and compliance in healthcare preferred.

Responsibilities

• Oversees adherence to the compliance program using the OIG Guidance as a guide.
• Assist the General Counsel in implementing a compliance committee and lead meetings.
• Establish methods to improve efficiency and reduce fraud, abuse and waste, and other risks.
• Investigate and respond to compliance issues from employees, regulators, payers, and clients.
• Review government health plan publications and train staff on changes.
• Periodically revise the compliance program to reflect changes in laws and policies.
• Coordinate with HR and Provider Enrollment to avoid sanctions.
• Develop and participate in training programs on the compliance program.
• Coordinate internal compliance reviews and monitor activities.
• Independently investigate and act on compliance matters and coordinate corrective actions.
• Develop policies encouraging reporting of suspected fraud.

Skills

Excellent organizational skills

Excellent written and oral

Analytical skills

Education

Undergraduate degree in related field

ICD10-CM and CPT knowledge

Federal regulations and policies knowledge

4+ years coding experience

3+ years auditing experience

1-2 years supervisory experience

Medical billing and compliance experience

Job description

RiseMe is seeking a Compliance Manager to assure that the Company and all stakeholders adhere to the letter and spirit of applicable government laws, regulations, policy and procedures.

You will oversee the compliance program, lead the compliance committee, train staff, investigate issues, and coordinate internal reviews with various departments to reduce risk and ensure accurate coding, billing, and reporting.