MERIDIAN MEDICAL MANAGEMENT (“M3”) is a leading provider of outsourced revenue cycle, EMR and IT support services to health care providers throughout the United States, with over 1,500 physicians served. We are unique in the industry by providing our clients a full suite of integrated business and IT solutions, including revenue cycle management, EMR deployment, support and business intelligence. Leveraging over a decade of experience, M3’s team of professionals enable some of the country’s most prestigious medical groups to optimize revenue cycle performance, secure actionable business intelligence and drive practice growth.
The Compliance Manager serves as a key member of the Compliance and Quality Team in executing the required Compliance Program Initiatives across the organization; provides direction and oversight to the Compliance Auditors and QA Supervisor; ensures the execution of the Audit and QA programs; aggregates and analyzes QA and audit findings and prepares reports for the management and leadership teams; works in concert with the Compliance Officer on the development and implementation of compliance policies/procedures and training materials; conducts compliance research and investigations; counsels provides guidance on complex coding and compliance issues.
General and Coding Compliance
1. Assist the Chief Compliance Officer (“CCO”) with the execution of the corporate compliance program across the organization.
2. Conducts annual compliance audits to test the effectiveness of the Company’s Corporate Compliance Program, prepares summary reports to include coding and billing error rates.
3. Reviews reported compliance, coding or billing issues, concerns or questions relative to compliance matters and provides support and guidance as appropriate.
4. Facilitates the development of written policies, procedures and standards based on applicable federal and state laws and regulations.
5. Maintains a system for confidential reporting and investigation of compliance concerns with an appropriate response process.
6. Facilitates company-wide training on the corporate compliance programs elements, including written materials and training programs designed specifically to promote understanding of compliance issues including correct coding techniques, laws and regulations, along with the consequences of non-compliance.
7. Maintains a consistent management of reporting and documentation processes that provides timely and relevant information on all aspects of compliance issues.
8. Coordinates employee concerns, as applicable, with Human Resources and interacts with other managers, directors in the billing center, as needed.
9. In coordination with the CCO, revises the compliance program to improve its effectiveness or in response to changing organizational needs or new/revised regulations, policies and guidelines.
10. In coordination with internal and external resources, maintains awareness of laws and regulations. Keeps abreast of current changes that may affect operations. Utilizes personal initiative, seminars, training programs, peer contact and various industry information sources (i.e., internet sites, newsletters, etc.).
Compliance Audit and Quality Assurance
1. Executes/manages the Company’s Audit and Quality Assurance Programs.
2. Facilitates, per the Company’s Audit Plan, the implementation and maintenance of audit controls and measurements for internal processes, ensuring correct processes are in place for accurate, complete and compliant programs across the billing centers.
3. Manages the Quality Assurance supervisor in the continuous monitoring of revenue cycle functions, performs aggregation and analysis of data and prepares summary reports.
4. Participates in periodic compliance/QA meetings with internal managers and our outsourced vendors.
5. Effectively utilizes multiple Practice Management Systems to execute the physician audit and internal QA programs.
1. In conjunction with the CCO, conducts reviews of impermissible HIPAA Privacy disclosures.
2. Executes appropriate follow up including client notification, remedial education and required documentation for reporting purposes.
3. Maintains the Disclosure Database to ensure immediate retrieval of disclosures as requested.
- Associates Degree in related field preferred.
- Current Coding Certification required
- Current Compliance Certification required or obtained within 9 months
- Auditing Certification preferred
3 or more years’ experience in the following:
1. Working knowledge of all functions along the revenue cycle
2. Experience with revenue cycle auditing and quality monitoring
3. Ability to aggregate and analyze audit and quality metrics
4. Ability to prepare audit, QA and compliance summary reports