Integrity Manager

Brightli • Springfield, MO

8h

About The Position

Job Summary: The Integrity Manager is responsible for overseeing and managing the Compliance Integrity Specialists and ensuring the accuracy, consistency, and effectiveness of proactive fraud, waste and abuse monitoring activities, including but not limited to, compliance audits and billing, coding and documentation related investigations across assigned markets. This role requires in-depth knowledge of state and federal billing, coding, and documentation regulations related to behavioral and medical health services within relevant assigned markets. The Integrity Manager ensures proactive fraud, waste and abuse monitoring activities are meaningful, risk-focused, and aligned with regulatory requirements. This position reports to the AVP of Compliance. Essential Job Functions: Oversee and manage assigned Integrity Specialist team, ensuring timely, high-quality audit performance and billing investigations across assigned markets. Knowledgeable of all applicable federal and state billing, coding, documentation, and reimbursement regulations, manuals, and standards across assigned markets. Review and validate audit methodologies, findings, and conclusions of Integrity Specialists to ensure accuracy, consistency, and meaningful outcomes. Provide guidance and expertise on complex regulatory and compliance issues related to behavioral and medical health services. Hire, train, mentor, and support Compliance Integrity Specialists. Assist in the development and maintenance of audit standards, tools, and processes to promote consistency and effectiveness. Assist with the development and improvement of policies, procedures and corrective action plans related to complaint billing and documentation. Collaborate with Deputy Integrity Officer, market Compliance and Privacy Officers, clinical leaders, and operational teams to ensure work of Integrity Specialists is meaningfully communicated. Identify trends, systemic risks, and recurring compliance issues within assigned markets and recommend corrective actions. Review reports and communication from Integrity Specialists to ensure they aid in understanding and effectively communicate important points. Support the development and delivery of compliance education and training based on audit outcomes. Monitor regulatory changes and ensure audit practices remain current. Prepare and present audit summaries, trends, and recommendations to compliance leadership, as necessary. Provide interim coverage for other Integrity Coordinators, as needed. Perform other compliance-related duties as assigned.

Requirements

• Advanced knowledge of federal and state healthcare billing, coding, and documentation regulations.
• Strong understanding of ICD-10, CPT, and HCPCS coding guidelines.
• Demonstrated leadership and people management skills.
• Strong analytical, critical thinking, and problem-solving abilities.
• Ability to interpret complex regulations and apply them to audit activities.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
• High level of professionalism and ability to maintain confidentiality.
• Associate’s degree in Health Information Management, required
• Relevant certification RHIA or RHIT, required.
• Minimum of 3–5 years of experience in healthcare compliance, auditing, coding, or billing.
• Prior supervisory or management experience required.
• Successful completion of background check including criminal record, driving record, abuse/neglect, and fingerprint check.
• Completion of New Hire Orientation at the beginning of employment.
• All training requirements including Relias at the beginning of employment and annually thereafter.
• Current driver’s license, acceptable driving record and current auto insurance.
• ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

Nice To Haves

• Bachelor’s degree in Health Information Management preferred.
• CCS/CPC, a plus.
• Behavioral health experience preferred.

Responsibilities

• Oversee and manage assigned Integrity Specialist team, ensuring timely, high-quality audit performance and billing investigations across assigned markets.
• Knowledgeable of all applicable federal and state billing, coding, documentation, and reimbursement regulations, manuals, and standards across assigned markets.
• Review and validate audit methodologies, findings, and conclusions of Integrity Specialists to ensure accuracy, consistency, and meaningful outcomes.
• Provide guidance and expertise on complex regulatory and compliance issues related to behavioral and medical health services.
• Hire, train, mentor, and support Compliance Integrity Specialists.
• Assist in the development and maintenance of audit standards, tools, and processes to promote consistency and effectiveness.
• Assist with the development and improvement of policies, procedures and corrective action plans related to complaint billing and documentation.
• Collaborate with Deputy Integrity Officer, market Compliance and Privacy Officers, clinical leaders, and operational teams to ensure work of Integrity Specialists is meaningfully communicated.
• Identify trends, systemic risks, and recurring compliance issues within assigned markets and recommend corrective actions.
• Review reports and communication from Integrity Specialists to ensure they aid in understanding and effectively communicate important points.
• Support the development and delivery of compliance education and training based on audit outcomes.
• Monitor regulatory changes and ensure audit practices remain current.
• Prepare and present audit summaries, trends, and recommendations to compliance leadership, as necessary.
• Provide interim coverage for other Integrity Coordinators, as needed.
• Perform other compliance-related duties as assigned.

Benefits

• Paid time off: full-time employees receive an attractive time off package to balance your work and personal life
• Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more
• Top-notch training: initial, ongoing, comprehensive, and supportive
• Career mobility: advancement opportunities/promoting from within
• Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree