Compliance Director – Medical Billing Service

Compliance Director – Medical Billing Service

Medical Billing Service

Ensures companywide knowledge, adherence, and compliance with healthcare billing and privacy laws and regulations including CMS guidelines as well as applicable state, local, and federal laws and regulations.

Major Responsibilities/Activities:

  • Conduct Internal Compliance Investigations and Reviews throughout the billing process and provide detailed recommendations to Compliance Officer and Management.
  • Identify needs and opportunities to improve compliance initiatives; develop and communicate policies and procedures as needed for successful implementation.
  • Serve as ongoing resource to all departments and all locations for Compliance related inquiries.
  • Assist management in process improvements and monitor these improvements for consistent implementation.
  • Coordinate, manage, and communicate reviews between internal staff, clients, and external parties as necessary to ensure alignment and timely response.
  • Coordinate Internal Response to all Government, Payor, and Client Initiated Audits, Communicate findings to internal staff, Conduct appeals to Payor as necessary.
  • Maintain up-to-date knowledge of all relevant billing and privacy laws and regulations and communicate internally as appropriate.
  • Participate in internal committees to provide compliance education and support.
  • Develop Educational Materials and Conduct Ongoing Compliance Training.
  • Investigate, Respond to, and Communicate response to all Compliance Related inquiries in a timely manner.
  • Collaborate with other internal staff to identify appropriate corrective actions when problems arise to not only address the problem but also prevent further occurrences.

Required Education, Skills, & Experience:

  • Bachelors degree in healthcare, business, or related field with at least 3 years of direct experience in healthcare compliance and reimbursements or 6+ years of direct experience in healthcare compliance and reimbursements.
  • Strong, demonstrated knowledge of all aspects of healthcare compliance.
  • Demonstrated understanding of medical billing cycle and payor rules and regulations.
  • Strong decision-making, problem-solving, critical thinking, and analytical skills with the ability to identify the cause and effect of problems and determine appropriate next steps/corrective action.
  • Ability to develop effective educational materials and train others to achieve results.
  • Willing and able to travel, sometimes on short notice, to various business sites, conferences, etc.

Preferred Education, Skills, & Experience:

  • Healthcare compliance certification strongly preferred.
  • Clinical healthcare experience.
  • Prior experience in EMS industry and/or ambulance billing.
  • Legal background a plus.

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