Associate Compliance Manager

We are seeking an Associate Compliance Manager who will provide oversight, training, guidance and assistance to Compliance Auditors and Sr. Compliance Auditors in the daily routine tasks of their position, under supervision of the Director. Collaborate with the Director to assure consistent quality performance amongst all auditors. Responsible for balancing workload, assuring that responsibilities of the group are completed within established time frames and making recommendations to improve workflow, processes and productivity. Provide input and assist in performance evaluations and improvement actions.

Specific Duties & Responsibilities

• Trains or assists in the training of new Auditor/Trainers to ensure uniformity and quality of work. This includes the performance of documentation reviews, conducting individual and group training sessions, using appropriate resources to research questions from providers and billing staff and use of audit software.
• Meets regularly with the Auditors/Trainers to review the progress of work and address any impediments to meeting deadlines.
• Provides regular updates and presents issues that require management involvement to the Director.
• Assigns work, balances workload and adjusts priorities in consultation with the Director.
• With the Director input, sets productivity goals and quality standards for the Auditors/Trainers and produces and reviews reports to monitor progress.
• Assists in training physicians, other clinicians, billing office staff and others with clinical documentation and coding requirements for professional fee billing.
• With the Director, establishes a protocol to collaboratively work with the CPA’s Physicians Billing Service and JHHS’s Compliance Office to investigate and resolve billing complaints, operational issues and/or errors that impact hospital and professional fee billing.
• Ensures the quality of the audit work and reports prepared by the Auditors/Trainers under his/her responsibility.
• Prepares and revises policies and procedures for the Auditors/Trainers.
• Performs other compliance related activities as necessary.

Scope of Responsibility

• Knows the formal and informal departmental goals, standards, policies and procedures which include familiarity of other departments within the school/division.
• Is sensitive to the relationship of both people and functions within the department, the Clinical Practice Association and JHHS Compliance Office.

Decision Making

• On a regular and continual basis, exercises administrative judgment and assumes responsibility for decisions, consequences, and results having an impact on people, costs, and/or equality of service within the functional area. Routinely handles confidential patient information and sensitive financial information.

Authority

• Lead will train new staff in auditing processes and office procedures and review and correct the work of other Auditors/Trainers. Lead will assign and reassign work to assure reviews are completed on time, training is conducted, and meetings are held as necessary.
• Auditors/Trainers may be asked to assist with training new staff or correcting the work of others.
• Identifies and suggests process and operational improvements.

Communications

• Exchanges non-routine information using tact and persuasion as appropriate requiring good oral and written communication skills.

Special Knowledge, Skills & Abilities

• Requires a detail-oriented individual with the ability to handle a high volume of multiple tasks and follow through to completion.
• Must be able to learn quickly and work independently to address a variety of complex issues.
• Must be flexible to adjust to the development and refinement of new processes and procedures.
• CPT and ICD-9 coding required, including coding from clinical documentation or auditing the coding of others.
• Extensive knowledge of Medicare regulations regarding teaching physicians, documentation guidelines, and other federal and state laws and regulations concerning clinical documentation, coding, and reimbursement.
• Demonstrated communication, analytical and organizational skills are essential.
• Proficient in Microsoft Word applications including Excel and Word, Outlook or equivalent e-mail, and internet usage. Experience with IDX Billing and Accounts Receivable system, EPR, Meditech, Eclypsis, Epic, and other clinical information systems preferred. Must be self-motivated and comfortable working independently, as a team leader and as a team member.

*This description is a general statement of required major duties and responsibilities performed on a regu