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Under the direct supervision of the Executive Director of Revenue Cycle, this position contributes to the DMEI mission and core values by serving as a leader in the department of compliance. The Compliance Manager is responsible for the implementation and facilitation of ongoing compliance auditing, monitoring, reporting and education activities for the compliance department of Dean McGee Eye Institute. This position will provide oversight and have primarily responsibility for ensuring that there is an effective compliance program and oversight in place for the compliance department. Additionally, the Compliance Manager will oversee activities necessary to ensure revenue cycle components remain in compliance with all local, state and federal healthcare program rules, regulations and administrative requirements.
Oversees and documents all internal and external regulatory investigations and audits related to revenue cycle compliance.
Monitors, analyzes, interprets, and communicates regulatory changes related to coding, billing and collections.
Leads and oversees efforts to respond to new or changing regulations, including but not limited to communicating regulations to site leadership and affected departments, assembling and chairing work teams, and developing/providing education regarding regulatory requirements.
Manages the process for receiving, documenting, tracking, investigating and addressing internal/external complaints regarding regulatory requirements
Ensures compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS), as well as other federal and state laws and regulations that govern matters related to the revenue cycle.
Performs follow-up to ensure timely repayment is made for all identified overpayments received from government agencies, health plans and patients.
In collaboration with compliance and revenue cycle leadership, develops and/or oversees compliance policies and procedures related to the organization's revenue cycle
Reduces organization risk by identifying risks related to the revenue cycle and by developing and managing annual work plan to address those identified risks.
Contributes to the annual compliance audit plan, and oversees the components related to revenue cycle activities
Conduct work plan reviews and document results; implement corrective action plans as required.
Develops and delivers education and supporting tools related to revenue cycle compliance.
Leads and/or participates in projects related to the design, implementation, revision or maintenance of processes and systems that promote compliance related to the revenue cycle.
Serves as internal expert and advisor in compliance matters related to coding, billing and documentation.
Collaborates with key leadership, employees, and contractors to promote revenue cycle compliance.
Collaborates with department leaders on their ongoing monitoring efforts, and any corrective action plans associated with identified deficiencies or trends.
Work collaboratively with leadership, management, legal counsel and regulatory agencies.
Analyze, track data, and create reports to assist in the analysis of compliance issue patterns.
Assimilate, interpret and communicate policy and regulations into operational activities.
DMEI Core Values and Competencies
Refer to DMEI Core Values and Competencies statement
This position has supervisory responsibilities.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is occasionally required to stand, walk; sit; use hands to finger, handle, or feel objects, tools of controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk of hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Education and Experience
Proficiency with Microsoft Office (Microsoft Excel, Microsoft Outlook)
Requires a minimum of 2 years working in a compliance department as an Auditor or Manager
Bachelor’s Degree Preferred but not Required
CPC or CCS Certification Required
The Dean McGee Eye Institute is an Equal Opportunity, Affirmative Action M/F/V/D employer.
Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
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