TPE Paralegal

Summit Spine and Joint Centers; Lawrenceville (GA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Summit Spine and Joint Centers in Lawrenceville, GA is seeking a compliance professional to lead Medicare Targeted Probe and Educate (TPE) processes across multiple clinics. This office-based role offers hybrid flexibility and reports to the General Counsel.

You will track audits, coordinate medical records, monitor testing denials, prepare appeals, and provide data-driven recommendations to leadership to mitigate risk and improve processes within the SSJC network.

Qualifications

• Bachelor’s degree in Healthcare Administration, Legal Studies, Business Administration, or related field.
• Experience managing Medicare audits, appeals, compliance programs, or revenue cycle operations.
• Strong understanding of Medicare regulations, medical documentation requirements, and reimbursement processes.
• Experience in healthcare compliance, legal support, paralegal work, or regulatory affairs.

Responsibilities

• Manage end-to-end Medicare Targeted Probe and Educate (TPE) process for all assigned providers and clinics.
• Track and monitor audit activity, provider status, deadlines, and documentation requirements throughout each stage of the TPE process.
• Coordinate the collection, review, and submission of medical records and supporting documentation for Medicare audits.
• Monitor urine drug testing claims, denials, and reimbursement trends to identify potential compliance risks and revenue impacts.
• Prepare, organize, and submit appeal, redetermination, and reconsideration packages accurately and within required timelines.
• Serve as the primary liaison between Compliance, Billing, Operations, Revenue Cycle, and clinical teams regarding TPE-related matters.
• Maintain detailed audit logs, status reports, and tracking tools to ensure no deadlines or submissions are missed.
• Analyze audit findings and trends, providing recommendations to leadership on process improvements and risk mitigation strategies.
• Assist with provider education and corrective action initiatives based on audit outcomes and Medicare guidance.
• Collaborate with compliance leadership to ensure adherence to federal regulations, Medicare policies, and organizational standards.
• Generate routine reports and updates for executive leadership regarding audit activity, outcomes, appeals, and financial impact.
• Support special projects and administrative initiatives for the Compliance Department as assigned.
• Provide additional support to the Compliance team and designated leadership as needed.

Skills

Analytical skills

Communication skills

Problem-solving

Organizational skills

Attention to detail

Education

Bachelor's degree in Healthcare Administration, Legal Studies, Business Administration, or related field

Tools

Microsoft Excel

Reporting tools

Job description

Company Overview

Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management group practice providing integrated clinical, surgical, and imaging services. With clinic locations across Georgia, North Carolina, South Carolina, and Tennessee, our care teams include Integrated Pain Solutions in North Carolina and Savannah Pain Management in Georgia, all operating as part of the SSJC organization. As one of the largest single-specialty practices in the nation, we are committed to collaboration, high-quality patient-centered care, and supporting our teams as we continue to expand. We are seeking motivated, qualified professionals to join us in delivering exceptional care across our growing network.

This job is a full-time, benefited position at Summit Spine & Joint Centers that reports to the General Counsel. This position’s primary location will be at the Administrative Building in Lawrenceville, GA.

Responsibilities

• Manage and oversee the end-to-end Medicare Targeted Probe and Educate (TPE) process for all assigned providers and clinics.
• Track and monitor audit activity, provider status, deadlines, and documentation requirements throughout each stage of the TPE process.
• Coordinate the collection, review, and submission of medical records and supporting documentation for Medicare audits.
• Monitor urine drug testing claims, denials, and reimbursement trends to identify potential compliance risks and revenue impacts.
• Prepare, organize, and submit appeal, redetermination, and reconsideration packages accurately and within required timelines.
• Serve as the primary liaison between Compliance, Billing, Operations, Revenue Cycle, and clinical teams regarding TPE-related matters.
• Maintain detailed audit logs, status reports, and tracking tools to ensure no deadlines or submissions are missed.
• Analyze audit findings and trends, providing recommendations to leadership on process improvements and risk mitigation strategies.
• Assist with provider education and corrective action initiatives based on audit outcomes and Medicare guidance.
• Collaborate with compliance leadership to ensure adherence to federal regulations, Medicare policies, and organizational standards.
• Generate routine reports and updates for executive leadership regarding audit activity, outcomes, appeals, and financial impact.
• Support special projects and administrative initiatives for the Compliance Department as assigned.
• Provide additional support to the Compliance team and designated leadership as needed.

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Legal Studies, Business Administration, or a related field preferred.
• Experience managing Medicare audits, appeals, compliance programs, or revenue cycle operations.
• Strong understanding of Medicare regulations, medical documentation requirements, and reimbursement processes.
• Experience in healthcare compliance, legal support, paralegal work, or regulatory affairs.
• Exceptional organizational skills with a proven ability to manage multiple deadlines and high-priority projects simultaneously.
• Strong analytical, communication, and problem-solving skills.
• Advanced proficiency in Microsoft Office Suite, including Excel and reporting tools.

Work Environment

• Office-based role in our Lawrenceville, GA Admin building, with potential for hybrid flexibility.
• May require occasional overtime to meet deadlines.

The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, and vendors, including in busy, demanding, or stressful circumstances. The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period; manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, or coworkers’ work; and use established de-escalation and escalation procedures when appropriate. The employee must exercise sound judgment; maintain appropriate workplace boundaries; receive and respond to routine feedback and direction; protect confidential patient and business information; and address patient or workplace concerns through established supervisory and safety procedures. These functions are essential to the position.