About the position

Vituity is seeking a Manager, Compliance & Revenue Integrity to join their team. This role is responsible for providing ongoing advice, review, and resources for emerging risks to monitor compliance with state and federal requirements. The manager will handle escalations from billing and coding teams, prepare reports for leadership, lead the RCM Research Committee, and develop/implement internal privacy and compliance controls. They will maintain current knowledge of federal and state regulations, conduct internal audits, and assist with policy revisions. The role involves identifying compliance vulnerabilities, ensuring timely responses to reported concerns, and supporting specialized compliance training. Additionally, the manager will perform regulatory research, summarize information, and contribute to the annual Workplan and Risk Assessment process. Other duties include coordinating external audits, analyzing coding application measures, communicating trends, participating in webinars, offering recommendations for CMS programs, monitoring team members, and ensuring compliance with government requirements. The role also involves managing incident tracking, overseeing corrective action plans, and improving systems for tracking incidents. A key aspect is acting as a steward of ethical standards and promoting a compliant culture, while also researching and authoring educational materials and participating in compliance projects.

Responsibilities

• Provide on-going advice, review, and resources for emerging risks in order to monitor compliance with state and federal requirements.
• Manage and provide guidance on escalations from billing and coding teams, including responses to patient complaints, attorney inquires, payor disputes, refund requests and billing regulation changes.
• Prepares and maintains reports for Vituity Compliance Program Leadership, Compliance Committee, senior leadership, and the Board of Directors.
• Leads RCM Research Committee.
• Develops and implements effective internal privacy and compliance controls to prevent and detect patterns of illegal, unethical, or improper conduct by MBSI employees, agents, affiliated providers, or other workforce members.
• Maintains a current working knowledge of Federal and State regulations and policies as they affect operations through routine review of various manuals (CMS, Federal Register notices, Medicaid, etc.) and on-line resources.
• Conduct or support routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits by external sources. Develops and maintains positive rapport with outside agencies.
• Assists in periodic reviews and revisions of enterprise and Compliance policies and procedures.
• Identifies compliance vulnerabilities and risks, and ensures that responses to reported concerns, alleged violations of and law, and/or conflicts of interest are timely, appropriate, and consistent.
• Prepares, maintains and distributes various compliance reports.
• Contributes to the annual Workplan and Risk Assessment process.
• Supports specialized compliance training throughout the organization (i.e. HIPAA, False Claims Act, Civil Monetary Penalties, Corporate Compliance/Ethics, etc.).
• Performs regulatory research on industry topics. Summarizes information, including as needed, development of billing/coding compliance guides/manuals.
• Performs other duties as assigned.
• Conducts routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits generated by external sources (CMS).
• Coordinate evaluations for measure-specific coding application and make recommendations, as needed.
• Completes analysis and communicates trends in errors or documentation concerns to the Director of Coding Compliance & Revenue Integrity.
• Participates in industry-related webinars and/or other conference calls, as needed, and summarizes information for team and for educational awareness messaging.
• Offers recommendations for CMS programs enhancement.
• Monitor activities of team members; provide feedback and counsel team members regarding performance.
• Ensures compliance with local, state, and federal government requirements.
• Assist with department tasks, as needed.
• Facilitate and lead projects to monitor and audit the performance of the Compliance Program and related activities on a continuing basis and in a collaborative and facilitative manner, ensuring goals of common stakeholders are met.
• Manages incident tracking process including documenting investigations, overseeing corrective action plans, creating toolkits to use in analysis, and reporting outcomes.
• Continually improve a centralized system for tracking incidents.
• Manages the monthly review of OIG Workplan updates to ensure alignment.
• Act as a steward by exhibiting sound ethical standards and consistently promoting a compliant culture.
• Research and author educational materials.
• Participate in Compliance Team Projects and initiatives when requested.
• Develop expertise and perform research in compliance subjects and issues when requested.

Requirements

• Bachelor’s degree in Business Administration, Healthcare, or related field desired Required.
• Minimum 5+ years of health care compliance experience or equivalent field required.
• Knowledge of and ability to apply Compliance policies, practices, systems, and standards required.
• Experience in the application of CMS Quality Program measures highly desired required.
• Ability to manage multiple tasks in a fast-paced, collaborative cross-functional environment.
• Ability to remain organized and effectively manage competing priorities while meeting deadlines.
• High attention to detail.
• Ability to analyze new or ambiguous information, define the issue or problem, and project plan the resolution.
• Ability to use analytical and creative problem-solving skills.
• Ability to strike a balance between showing initiative and seeking appropriate guidance and input from others.
• Excellent interpersonal skills, including conflict resolution.
• Ability to effectively communicate orally and written.
• Ability to use multiple Vituity systems and understand their connections and impact.
• Advanced proficiency in Microsoft O365 (Word, Excel, Outlook, SharePoint and PowerPoint).
• Knowledge of Health Information Management principles, policies and procedures.
• Knowledge of compliance principles, including Office of Inspector General Seven Elements.
• Knowledge of Healthcare systems, health plans, and/or physician groups.
• Knowledge of pathology and etiology of disease, body areas and organ systems
• Knowledge of CPT and ICD-10-CM coding practices and/or knowledge of Medicare/Medicaid billing practices and appeal process.
• Knowledge of Health Insurance Portability & Accountability Act (HIPAA), Fraud Waste & Abuse, and Emergency Medical Treatment and Active Labor Act (EMTALA).
• Knowledge of Medicare and Medicaid guidelines

Nice-to-haves

• Certified Procedural Coder (CPC certification, or equivalent, and/or Certification in Healthcare Compliance (CHC) preferred.

Benefits

• Superior health plan options
• Dental, Vision, HSA/FSA, Life and AD&D coverage, and more
• Top Tier 401(k) retirement savings plans that offers a \$1.20 match for every dollar up to 6% plus discretionary profit-sharing contributions (eligible January following 18 months of service)
• Generous paid time off starting 3-4 weeks’ annually
• Student Loan Refinancing Discounts
• Professional and Career Development Program
• EAP and travel assistance included
• Wellness program
• Purpose-driven culture focused on improving the lives of our patients, communities, and employees