Compliance Coding/Billing Manager

Job Description Summary

Reporting to the Vice President, Chief Compliance and Audit Officer, the Compliance Coding and Billing Manager is responsible for promoting ethical coding and billing practices across the entire spectrum of South Shore Health. In this leadership role, the Compliance Coding and Billing Manager oversees two coding and compliance auditors and has responsibility for developing and leading activities to ensure compliance with applicable laws, regulations and standards applicable to the South Shore Health System. The individual filling this role will serve as an expert in billing compliance related issues, offer guidance, and lead, as well as participate in, compliance investigations as required. They will coordinate all billing audit activities related to the billing compliance program. Develops and monitors a system of routine audits and monitoring that will assure that systems and processes are functioning correctly in order to comply with applicable laws.

Job Description

Job Responsibilities:

• Monitors organization wide compliance with federal and state billing regulatory guidance.

• Conducts prospective or retrospective coding and billing compliance audits.

• Serves as an independent resource to clinical or operational departments on coding, documentation and regulatory guidelines.

• Develops, prepares and reports compliance metrics to the Compliance Audit and Risk Committee and as needed.

• Assists the Chief Compliance Officer with the development and implementation of the annual compliance risk assessment and internal work plan.

• Participates in development training tools and materials.

• Delivers education to providers, clinical and department staff on compliant documentation and regulatory guidelines.

• Manages the Compliance audit team within the Compliance office.

• Identifies trends in billing, coding and documentation errors. Recommends and monitors implementation of corrective action plans.

• Develops SSH compliance policies and procedures as required.

• Performs other related duties as assigned.

Job Requirements:

Minimum Education - Preferred

Bachelor's Degree

Minimum Work Experience

5 plus years

Required Certifications

• CCA - Certified Coding Associate (AHIMA-American Health Information Management Assoc) or

• CCS - Certified Coding Specialist (AHIMA-American Health Information Management Assoc) or

• CCS-P - Certified Coding Specialist-Physician Based (AHIMA-American Health Information Management Assoc) or

• CPC - Certified Professional Coder (AAPC-American Academy of Professional Coders) or

• CPMA -Certified Professional Medical Auditor (AAPC-Academy of Professional Coders) or

• RHIA - Registered Health Information Administrator (AHIMA-American Health Information Management Assoc)

Knowledge, Skills and Abilities required:

• In depth knowledge and experience with Centers of Medicare and Medicaid Services regulatory guidance

• Audit methodology

• Ability to develop and effectively deliver coding/billing education to physicians and organization colleagues

• Proficiency with Microsoft Office applications