Billing Compliance Program Manager

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Job description

Description:

Under limited supervision, the Billing Compliance program manager will ensure that LifeMed Alaska (LMA) adheres to all applicable state and federal laws and regulations to ensure compliance in EMS charting and billing practices. In collaboration with LifeMed's leadership and operational teams, this role will be responsible for identifying issues and providing solutions to keep LifeMed on track for excellence. This position will serve as the main liaison between LifeMed and its outside billing partner.

EXPECTATIONS

Inspiring our team to achieve continuously improved results and excellence through:

1. Setting and communicating the highest expectations for performance while actively demonstrating personal belief in everyone's ability to realize superior results.
2. Establishing clear goals and associated metrics that support LifeMed Alaska's vision and drive sustainability.
3. Creating a climate of accountability at every level.
4. Ensuring an in-depth understanding of quality expectations.

Serve as an active agent in creating a culture that attracts and retains the best people through:

1. Recognizing individual and team accomplishments.
2. Involving team members in decisions that affect them through work groups and forums.
3. Creating a safe environment that ensures the best outcome for the patient and LifeMed Alaska.
4. Proactively supporting leadership initiatives among peer groups and other leaders.
5. Actively removing barriers to success for both the individuals and the team.

Proactively work to assist others in achieving LifeMed's objectives to be safe, sustainable, and leaders in our community.

ESSENTIAL JOB FUNCTIONS

1. Develop, implement and monitor LifeMed's billing compliance program, providing periodic reviews and updates as needed as regulations change
2. Works alongside education team to organize and conduct necessary industry training for appropriate personnel (HIPAA, CMS requirements)
3. Act as point of contact and works with billing partner to investigate and resolve internal and external reports of billing and regulatory compliance concerns
4. Maintains regulatory review and communicates to staff and billing agency any compliance updates and requirements
5. Monitors adherence with all applicable regulations, policies, and procedures and identifies potential vulnerability and risk areas to include audits of medical records and documentation to ensure accuracy, medical necessity, and regulatory review as appropriate
6. Investigates patient complaints, issues, and concerns and provides recommendations for corrective action
7. Identifies potential areas of compliance vulnerability and risk and communicates recommendations for improvement to appropriate stakeholders
8. Creates and maintains reports, guidelines and training materials for medical documentation best practices
9. Assist finance team and outside billing agency with financial data and patient account inquiries

Requirements:

Must possess required knowledge, skills, abilities, and experience and be able to explain and demonstrate, with or without reasonable accommodation, that the essential functions of the job can be performed.

• Strong communication and customer service skills
• Ability to work independently and be a self-starter
• Policy development and experience in writing standard operating procedures
• Critical thinking - able to handle complex situations and provide solutions
• Strong collaboration skills and ability to work within a team
• Knowledge of ambulatory and EMS industry documentation, to include billing practices and requirements. Background in mobile technologies and computer networking systems, including electronic medical information required.
• Working knowledge of MS Office (strong computer skills)
• Knowledge of Medicaid, Medicare, Managed Care, Private Insurance, Auto Insurance, and IHS regulations and requirements
• Knowledge of EMS industry charting and billing practices
• Industry knowledge and understanding of requirements under OIG to comply with CMS, HIPAA, EMTALA and STARK laws

ESSENTIAL JOB QUALIFICATIONS

(Any equivalent combination of knowledge, skills, abilities, education and experience)

Licensure: Certification from a professional organization (AAHAM, HFMA, AAPC, NAAC etc.) Preference will be given to those holding ambulance specific certifications. Obtain Certified Ambulance Compliance Officer (CACO), and Certified Ambulance Coder (CAC) designations within one year of appointment to this position and maintain current licensure.

Experience: 5+ years billing experience is required. Transport billing is preferred. 3+ years management experience is required. Must have knowledge of medical records and electronic information systems.

Skills and Qualifications: Microsoft 365 with emphasis on Microsoft excel including building formulas, workbooks, pivot table functions. Experience in accounts payable (A/P) and accounts receivable (A/R) duties with data input. Experience of working directly in an accounting role with responsibility for keeping and maintaining records, entering journal entries, and reporting.

Other Qualifications: Ability to read, analyze, and interpret policy and procedure manuals, and technical procedures. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, customers, and other employees. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Ability to interpret a variety of instructions and apply them to the situation.

Attendance: Regular attendance is required for this position.

English Language: Must be able to read, write and speak English.

PM21

Compensation details: 00 Yearly Salary

PI6984b7613b24-2404

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