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Medical Billing Compliance Manager 

EOE StatementWe are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

TruBridge is seeking a Medical Billing Compliance Manager to join our education team. The compliance manager will be expected to collaborate with multiple departments within TruBridge to develop a medical billing audit plan utilizing governmental resources, adjusting periodically as compliance guidance changes. Develop tools to gather audit data. Manage medical billing auditors to ensure audits are conducted as per company policies established. Educate staff performing duties impacting medical billing and collections, staff who audit and train these employees on the principles of medical billing compliance, and staff who train employees staff impacting medical billing and collections. Is cross-trained in other areas to support the needs of the Education Department.

These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job-related duties as required. Goals and objectives are
subject to change.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

  • Collaborate with the Corporate Compliance Committee and various departments within TruBridge who affect medical billing to establish medical billing compliance policies and procedures to meet governmental requirements. This is done in consultation with official published mandates and guidance, such as OIG Guidances, Federal Register, and CMS publications pertaining to medical billing compliance
  • Receive reports of external audits in progress at TruBridge clients receiving medical billing or collections services; reports this activity to the Corporate Compliance Committee
  • Assist TruBridge staff and its clients receiving medical billing or collections services in medical billing audit response as necessary – for both internal and external audits
  • Develop new hire and annual compliance educational materials pertaining to medical billing compliance; submit to the Corporate Compliance Committee for approval and publication and distribution to employees
  • Develop a medical billing audit plan annually, adjusting throughout the year as needed, utilizing OIG and CMS resources to identify “high-volume, high-risk” areas
  • Develop tools to gather audit data for reporting purposes
  • Manage medical billing auditors
  • Educate auditors on risk areas identified, auditing tools, and proper auditing technique
  • Ensure the proper number of audits per employee and per site are conducted as prescribed in company policies
  • Summarize audit results and report them to applicable leadership and the Corporate Compliance Committee
  • Identify staff education needs based on medical billing audit results, oversee and coordinate the creation of educational materials, and deploy said education
  • Collaborate with departments of CPSI who impact medical billing and collections (EHR software, medical billing software, coding software, collection software) when medical billing compliance matters may be resolved by table settings or programming changes.
  • Monitor OIG, Federal Register, CMS, and MAC resources to keep abreast of Federal changes impacting billing and reimbursement and collaborate with ARMS, Coding, Insurance services, and our company’s EHR groups to ensure all departments/divisions are aware and are prepared for impending changes.
  • Serve as the point person (with a backup) to whom company employees forward information learned or received relating to medical billing and collection compliance (examples of billing errors, changes in billing requirements, educational material pertaining to medical billing compliance); summarize and disseminate said medical billing compliance information to applicable staff
  • Work closely with the Education department to develop and deploy educational material and instruction

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and otherregulations, as appropriate.

Position Requirements

Minimum Requirements:
Education/Experience/Certification Requirements

  • Familiarity with Medicare billing guidelines, such as MSP, 72-hour, ABN, incident-to, modifiers that could be problematic for billing compliance (59, 25, KX), unbundling, Part B only, reference lab billing
  • Excellent communication (written and oral) and interpersonal skills
  • Strong organizational, multi-tasking, and time-management skills
  • Detail-oriented and able to follow through on issues to resolution
  • Able to act both independently and as a team member
  • Open-minded and able to collaborate with all levels of staff (subordinates, peers, management) and consider all suggestions in developing best practices
  • Minimum of Intermediate level of Excel experience
  • Comfortable speaking in a group setting
  • Able to present audit findings in a confident and constructive manner

Preferred Qualifications:

  • Any healthcare compliance certification (CHC, CPCO)
  • Prior position performing or responsible for the oversight of one or more of the following tasks: medical billing audits; response to RAC, ZPIC, or OIG audits or Corporate Integrity Agreement; research in the area of medical billing regulations and guidance
  • Prior Medicare billing experience
  • CAH billing experience
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This position is currently not accepting applications.

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