Manager Billing Compliance

Nicklaus Children's Health System in; Miami (FL); On-site; USD 60,000 - 95,000; Full time

Job summary

An established industry player is seeking a Manager of Billing Compliance to lead a dedicated team in ensuring adherence to healthcare regulations. This role involves overseeing auditing processes, developing compliance policies, and managing special projects. The ideal candidate will have a strong background in medical coding and billing compliance, along with proven leadership skills. Join a forward-thinking organization that values integrity and excellence in healthcare delivery, and play a crucial role in maintaining the highest standards of billing practices. If you are passionate about healthcare compliance and eager to make a significant impact, this opportunity is for you.

Qualifications

• 4-7 years of experience in billing compliance or medical coding.
• Leadership experience with a focus on team management.
• Strong understanding of federal/state billing regulations.

Responsibilities

• Oversee coding and documentation auditing activities.
• Manage a team of billing compliance personnel.
• Develop and analyze audit programs and schedules.

Skills

Healthcare Compliance

Medical Coding

Audit Management

Leadership

Analytical Skills

Problem-Solving

Time Management

Education

Bachelor's Degree in Healthcare Administration

Certified Coder (CPC, CCS, CPMA)

Certification in Healthcare Compliance (CHC)

Tools

Cerner

Job description

Manager Billing Compliance (Project Management)

Job Summary

Responsible for overseeing coding and documentation auditing activities (professional & facility services), policies and procedures, risk assessments, and developing written guidance for clinicians and operational leaders. Ensures compliance with federal/state laws, regulations, and Nicklaus Children's policies. Manages a team of three billing compliance personnel, workflow analysis, productivity, auditing, quality review, problem resolution, and supervision.

Job Specific Duties

1. Supervise billing compliance team, including work allocation, training, and performance quality.
2. Manage the audit program: develop, organize, track, and analyze audits.
3. Create audit schedules and manage workflows accordingly.
4. Communicate audit findings effectively through presentations, graphs, and reports.
5. Establish and review policies and objectives aligned with organizational goals.
6. Conduct Pro Fee and DRG validation audits to verify billing accuracy through coding and clinical documentation.
7. Consult with the compliance director for guidance.
8. Serve as a contact for billing compliance concerns, responding promptly and professionally.
9. Investigate billing compliance issues as directed by leadership.
10. Manage special projects, including ad hoc audits and government payer investigations.
11. Stay updated on federal and state coding and billing regulations; inform staff of changes.
12. Perform special audits and other assigned duties.
13. Evaluate audits and recommend new standards and reporting methods.

Minimum Qualifications

• Bachelor's Degree in Healthcare Administration, Business, or related field, or 4-7 years of equivalent experience.
• Certified Coder (CPC, CCS, CPMA).
• Certification in Healthcare Compliance (CHC) within 1 year of hire.
• 4-7 years of experience in billing compliance, medical coding, or related fields.
• 4-7 years of supervisory experience.
• 3-5 years of audit experience.

Knowledge, Skills, and Abilities

• Thorough understanding of DRGs, hospital billing, coding, and documentation.
• Knowledge of CMS guidelines.
• Ability to maintain confidentiality.
• Strong follow-through, regulatory adherence, and proactive planning skills.
• Leadership ability in a team environment with minimal supervision.
• Analytical and problem-solving skills.
• Excellent time management and organizational skills.
• Discretion, tact, diplomacy, and judgment.
• Systems knowledge of Cerner.
• Knowledge of healthcare billing regulations at federal and state levels.