Clinic Compliance Manager

Tufts University•Boston, MA

9h•Hybrid

About The Position

Tufts University School of Dental Medicine (TUSDM) has established a formal institutional Compliance Program to ensure adherence to all Federal, State, and Accreditation Regulations, particularly those concerning Anti-Kickback, Fraud and Abuse, and HIPAA Privacy and Security. The TUSDM Compliance Program aims to disseminate legal, regulatory, and policy changes to the TUSDM Workforce and foster an ethical, law-abiding culture. As mandated by the Federal Government for Healthcare Providers and Covered Entities, this role supports the Compliance, Academic, and Clinical Mission of TUSDM by monitoring, preventing, and correcting potential non-compliant actions or behaviors.

Requirements

Bachelor's Degree
7+ years of current billing and medical coding audit work within a physician/dental practice or hospital system.
Demonstrated knowledge of insurance carriers, Medicare and Medicaid reimbursement plans, commercial dental/medical, insurance coding and billing practices (third-party billing), and dental patient care systems.
Familiarity with ADA (dental) codes, ICD-9/10, and CPT Codes.
Proficiency in Microsoft Word, Excel, PowerPoint, Outlook, email, and internet usage.
Coding Instructor credentials
Certified Dental Coder (CDC)

Nice To Haves

Familiarity with Axium, Dentrix, or Epic

Responsibilities

Develop and oversee Compliance Audit Work Plans for Pre-Doctoral and Post-Graduate Clinics.
Perform routine compliance audits of Dental Clinics to determine medical necessity and the level of care billed for services rendered, in accordance with Medicare, Medicaid, other federal insurance programs, and third-party payer regulations.
Provide guidance, training, and education to the TUSDM Workforce, including Students, Residents, Fellows, Faculty, TUSDM-sponsored Visitors, Staff, and Volunteers.
Suggest corrective action plans when applicable.
Collaborate with Clinical Affairs, Practice Managers, the TUSDM Billing Department, and other relevant entities/third-party payers to identify and analyze billing, documentation, and regulatory guidelines impacting TUSDM's Compliance efforts, revenue cycle, and Academic or Research Missions.
Conduct accurate and compliant compliance reviews of medical records and provider services to identify and report audit outcomes and the need for coding education.
Develop and recommend appropriate action plans to correct instances of non-compliance.
Formulate and update annual billing guidelines and policies for providers' billing of all professional fees (medical and dental).
Develop appropriate training materials and programs for TUSDM's providers, clinical, and administrative staff in coding and documentation.
Develop and implement an effective training and education program for clinical and non-clinical staff affected by billing compliance, including providers, independent contractors, and other department staff.
Monitor pre and post-billing compliance and assist in reducing identified problem areas using audits and risk evaluation techniques.
Conduct analyses and make recommendations as needed.
Develop written reports documenting audit findings and recommendations.
Compile audit results using an audit database.
Conduct and participate in TUSDM meetings.
Provide education and training on coding-related areas to TUSDM Students, Faculty, Staff, and all Workforce Members.
Manage and coordinate effectively with regulatory agencies and third-party payors for requests, inquiries, and/or investigations.
Undertake other projects as requested.