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Charter Healthcare · 4 months ago

Compliance Pre-Billing Manager

Rancho Cucamonga, CA

Full-time

Onsite

Senior Level

5+ years exp

Charter Healthcare is seeking a Compliance Pre-Billing Manager responsible for overseeing compliance and audit programs related to Medicare/Medi-cal and other payors. The role involves managing billing audits, ensuring compliance with regulatory requirements, and providing guidance to management and staff on compliance initiatives.

Health CareMedical

Responsibilities

Provide oversight and management of all billing audits

Oversight and tracking of all agencies pre-billed claims and maintain comprehensive information on the billing status and communication with the billing department

Facilitates the organization and reviews medical records and billing/claim information for each claim requested for Additional Documentation Review or other medical records requests

Monitors and analyzes trends in disallowed claims and prepares reports as requested for agency leadership with additional training provided as needed

Implement and maintain a system of management reporting that provides timely and relevant information on all aspects of audit and compliance issues

Develops and ensures efficient processes for documenting all compliance-related initiatives and activities

Establish audit controls and procedures to monitor operational effectiveness and fiscal integrity

Provide guidance to management, medical staff, and individual departments so that clinical and other ancillary staff are aware of their responsibility for ensuring compliance with those areas

Foster open lines of communication and exercise authority to apprise department heads of any issues of concerns relating to compliance activities and procedures

Monitor and analyze trends in disallowed claims and prepare reports as requested for agency leadership with additional training provided as needed

Monitors CMS, FI, MAC, state, and local guidelines to determine changes to documentation and billing requirements

Develops and ensures efficient processes for documenting all compliance-related initiatives and activities

Develop and recommend annual compliance and internal Quality Assurance (QA) audit programs and reports conclusion and recommendations to QA committee and Board of Trustees

Develop policies and procedures that set up standards for internal audit and compliance, giving specific guidance to management, medical staff, and individual department as appropriate

Direct efforts to communicate compliance initiatives including written materials and training programs designed specifically to promote awareness and understanding of compliance issues

Reviews complaints, concerns, or questions related to compliance issues and provide consultative leadership and support as necessary

Support and participate in all quality improvement initiatives

All other duties and responsibilities as assigned

Qualification

Healthcare Compliance CertificationHealthcare organization experienceComplianceAudit experienceData interpretationProject management skillsInterpersonal skillsExcelMicrosoft WordCommunication skillsAttention to detailOrganizational skills