Job Description

Job Summary:
We are looking for a Compliance Officer (Medical Billing & Coding) who can support us for conducting scheduled and unscheduled patient and professional audits and projects related to billing and payment integrity, workflow, and duties in order to ensure accurate and timely responses. Oversees, coordinates, and conducts audits on documentation, abstraction, and coding to ensure compliance with our Organization's guidelines and prepares policies and procedure manuals and any other formal documents as required.

Must have experience and expertise to write office and clinic operations policy and procedure manuals.

Must have deep understanding and knowledge of CMS regulatory landscape as it pertains to the following:

1. Outpatient services, E&M coding, CPT codes, CCI, MIPS, MACRA

2. Sleep and other diagnostics

3. CMS Audits

4. DME billing requirements and compliance requirements

5. Population health services like CCM. PCM, RPM and RTM

6. Healthcare cybersecurity and HIPAA

Must-Have Qualifications:

• Bachelor's Degree with 10 years experience in a compliance office or the equivalent;
• The American Academy of Professional Coders (AAPC) recognized coding certification (CPC, CPC-H, ACS, CCS-P/H, RHIA);
• Knowledge of medical auditing, State and Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD-10, CPT, HCPCS, DRG coding;
• Proficient with word processing, spreadsheet and related computer applications;
• Demonstrated human relations and effective communication skills also required.

Essential Functions:

• Oversees, coordinates, and conducts scheduled and unscheduled billing and coding audits to ensure compliance with Organization, State and Federal guidelines
• Assist our organization in preparation for regulatory audits, by developing, monitoring, and updating quality controls and recommends actions to maintain compliance
• Must have experience and expertise to write office and clinic operations policy and procedure manuals.
• Recommends enhancements to facility and professional operating policies and procedures, based on audit results and/or billing and payment integrity data.
• Teams with providers, managers and staff to assist in implementing, coordinating, and monitoring compliance practices.
• Serves as an expert resource in issue resolution

Job Type: Full-time

Pay: ?50,000.00 - ?75,000.00 per month

Schedule:

• Monday to Friday

Application Question(s):

• What would be your pay expectation?

Education:

• Bachelor's (Required)

Experience:

• Healthcare Compliance: 10 years (Required)

Language:

• English (Required)

License/Certification:

• AAPC recognized coding certification (Required)

Work Location: Remote