Manager, Compliance
Description
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
What you’ll be doing:
The Compliance Manager reports to the VP of Compliance and is responsible for leading the compliance regulatory monitoring function and the compliance audit plan and will focus on activities within Revenue Cycle Management (RCS). The Compliance Manager is well-versed in laws and regulations impacting the healthcare industry along with knowledge of professional billing rules, CPT/HCPCS coding rules, and revenue management processes. The Compliance Manager is experienced in leading a team and overseeing day to day compliance functions. The Compliance Manager also supports various ah-hoc activities such as education content, risk assessments, internal audits, etc. as part of the company’s compliance program.
- Oversees Compliance Audit functions by ensuring the development of and adherence to the annual billing/coding audit plan.
- Oversees the Regulatory Compliance monitoring function by ensuring that we are appropriately tracking and in compliance with all new, existing and proposed federal and state legislation, laws, and regulations as well as payor rules and contracts.
- Collaborates with Revenue Cycle Services (RCS) to review findings of audits on processes, coding/billing, etc.
- Collaborates with other departments to ensure education and process implementation with respect to existing or new federal and state laws, regulations, legislation, etc.
- Assists in the monitoring of vendors compliance with Company rules and applicable law, including RCS vendors.
- Assists, as needed, with new business ventures and ensures processes are set up to comply with applicable federal and state laws and payor rules.
- Contributes to the Compliance Department annual workplan to improve overall program effectiveness.
- Conducts billing/coding audits or internal audits, as needed.
- Reviews the results of audits conducted by compliance auditors to ensure accuracy of documentation summaries, results, and corrective action.
- Utilizes data analytics to improve audit effectiveness and efficiencies.
- Routinely reviews and revises, as necessary, policies and procedures.
- Contributes to Company-wide Risk Assessment process.
- Prepares status reports on regulatory oversight, billing and coding audits, or other internal reviews for Compliance Leadership, the Corporate Compliance Committee, Quality and Compliance Committee, and any other reports as needed.
- Exhibits the Company’s Core Values and complies with the Code of Conduct.
Who/What we are looking for:
- Bachelors degree Required, Healthcare
- Masters degree Preferred, Healthcare
- CHC or RHIA Required
- CPC/CCS preferred
- 7+ years of Healthcare Compliance experience
- 5 years of management experience in a healthcare setting
- 3+ of professional coding and auditing experience
- Experience with regulatory review tools such as Lexis Nexis is preferred.
- Strong analytical and research skills. Must be able to recognize areas of the Company impacted by laws and regulations.
- Capacity to evaluate implications of laws, regulations, and related interpretations in the context of SCP Health’s clinical and business settings.
- Experience with communicating audit observations and recommendations.
- Experience with healthcare revenue management including auditing professional billing processes.
- Familiarity with healthcare revenue management processes and systems.
- Proven experience as a manager.
- Methodical and diligent with outstanding planning and record keeping skills.
- Excellent organizational and communication skills.
- Strong computer skills (excel, and handling large data sets)
- Ability to work independently and handle multiple tasks/projects at the same time.
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