Program Manager Revenue Integrity Compliance: Corporate Compliance

Hoag • Costa Mesa, CA

4d

About The Position

The Program Manager Revenue Integrity Compliance supports implementation of the Revenue Integrity Compliance Program for Hoag Memorial Hospital Presbyterian and its affiliated companies (collectively “Hoag”). The Program Manager Revenue Integrity Compliance is a key corporate compliance role providing onsite support of billing, coding and revenue cycle compliance related matters for Hoag enterprise-wide. Possesses working knowledge of revenue cycle operations, regulatory and compliance rules and regulations, various payer reimbursement practices and government billing audits. In collaboration with the Sr. Principal, Revenue Integrity Compliance, the implements processes to prevent fraud, waste, and abuse. Researches and interprets billing and coding guidelines and CMS reimbursement regulations applicable to Hoag service lines. Develops presentations, education and provide training on new standards and conduct audits to ensure compliance. Under limited supervision, supports the operations of the Revenue Integrity Compliance Program which includes special projects, assessment and analysis, performing audits, conducting investigations, responding to compliance questions and working with the revenue cycle departments. Performs other duties as assigned.

Requirements

• A minimum of four (4) years of relevant compliance and/or revenue cycle experience in an acute care setting or multi-specialty medical group.
• Working knowledge of government and commercial billing and coding regulations and guidance.
• Familiarity with Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and other CMS billing and coding guidelines for Hoag services.
• Certified in Healthcare Compliance (CHC) or other compliance or coding certification subject to approval by the Sr. Principal Revenue Integrity Compliance or must obtain certification within 6 months of hire.

Nice To Haves

• Epic experience preferred.
• Certified Coder Professional (e.g., CPC, COC, CPMA), or Certified Coding Specialist (CCS)

Responsibilities

• Supports implementation of the Revenue Integrity Compliance Program for Hoag Memorial Hospital Presbyterian and its affiliated companies
• Provides onsite support of billing, coding and revenue cycle compliance related matters for Hoag enterprise-wide
• Implements processes to prevent fraud, waste, and abuse
• Researches and interprets billing and coding guidelines and CMS reimbursement regulations applicable to Hoag service lines
• Develops presentations, education and provide training on new standards and conduct audits to ensure compliance
• Supports the operations of the Revenue Integrity Compliance Program which includes special projects, assessment and analysis, performing audits, conducting investigations, responding to compliance questions and working with the revenue cycle departments
• Performs other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed