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Seattle Children's · 1 day ago

Professional Compliance Program Manager II

Seattle, WA

Full-time

Hybrid

Mid, Senior Level

$107K/yr - $161K/yr

5+ years exp

Seattle Children's is a leading pediatric healthcare organization dedicated to providing superior patient care and advancing research. The Professional Compliance Program Manager II will develop and oversee the professional compliance program, ensuring adherence to laws and ethical standards while managing compliance projects and audits.

BiotechnologyHealth CareHospitalHospitality

Responsibilities

Develop and oversee key elements of the professional compliance program for Seattle Children's employed and contracted providers

Design, implement, and manage the SC professional compliance program to ensure adherence to applicable laws, contractual obligations, internal policies, and ethical standards

Identify and lead special compliance projects or investigations related to coding, billing, reimbursement, and other regulatory matters

Contribute to the annual compliance work plan and advise the CO on billing and coding matters

Conduct research and analysis to support compliance decisions, including reviewing industry standards

Facilitate consultations for policy development or process improvements

Manage all components of the SC professional compliance program, performing some components such as annual audits and ad hoc investigations as directed by the CO

Track resolutions and identify trends in compliance issues, participating in identifying solutions and system changes

Track OIG work plan issues and CMS billing compliance initiatives, advising the CO on their impact

Present at board level meetings, large group training, and in interactions with the payer community

Develop goals, plans, and metrics, ensuring effective communication and implementation of initiatives

Represent the Professional Compliance Officer as needed

Qualification

Healthcare complianceFederal healthcare regulationsProject managementHealthcare managementCoding certificationAnalytical skillsTeam leadershipCommunication skills

Required

Bachelor's degree in a related field or equivalent combination of education and extensive work experience

Five years' experience in healthcare compliance or with progressive responsibility

Four years of experience in healthcare management or a supervisory role working with cross-functional teams, including analysis and reporting to deliver improved outcomes

Demonstrated experience leading projects, teams, and/or system improvements

Expert understanding of Federal and State healthcare statutes, regulations, and requirements for Federal healthcare programs, particularly as they relate to professional fee billing, including Teaching Physician Guidelines

Experience preparing and presenting information to a variety of roles, including providers, managers, and senior leaders in small or large group settings

Current Coding and/or Medical Records Certification (acceptable credentials include CCS-P, CPC)