Manager, Compliance & Revenue Integrity

Remote, Nationwide – Seeking Job Title Everybody Has A Role To Play In Transforming Healthcare At Vituity you are part of a larger team that is driven by our purpose to improve lives. We are dedicated to transforming healthcare through our culture by working together to tackle healthcare’s most pressing challenges from the inside. Join the Vituity Team. At Vituity we’ve cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than individual achievements, an approach we call “culture of brilliance.” Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done. Vituity Locations: Vituity has opportunities at 890 practices across the country, serving 14.5 million patients a year. With Vituity, if you ever need to move, you can take your job with you. The Opportunity Provide on-going advice, review, and resources for emerging risks in order to monitor compliance with state and federal requirements. Manage and provide guidance on escalations from billing and coding teams, including responses to patient complaints, attorney inquires, payor disputes, refund requests and billing regulation changes. Prepares and maintains reports for Vituity Compliance Program Leadership, Compliance Committee, senior leadership, and the Board of Directors. Leads RCM Research Committee. Develops and implements effective internal privacy and compliance controls to prevent and detect patterns of illegal, unethical, or improper conduct by MBSI employees, agents, affiliated providers, or other workforce members. Maintains a current working knowledge of Federal and State regulations and policies as they affect operations through routine review of various manuals (CMS, Federal Register notices, Medicaid, etc.) and on-line resources. Conduct or support routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits by external sources. Develops and maintains positive rapport with outside agencies. Assists in periodic reviews and revisions of enterprise and Compliance policies and procedures. Identifies compliance vulnerabilities and risks, and ensures that responses to reported concerns, alleged violations of and law, and/or conflicts of interest are timely, appropriate, and consistent. Prepares, maintains and distributes various compliance reports. Contributes to the annual Workplan and Risk Assessment process. Supports specialized compliance training throughout the organization (i.e. HIPAA, False Claims Act, Civil Monetary Penalties, Corporate Compliance/Ethics, etc.). Performs regulatory research on industry topics. Summarizes information, including as needed, development of billing/coding compliance guides/manuals. Performs other duties as assigned. Conducts routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits generated by external sources (CMS). Coordinate evaluations for measure-specific coding application and make recommendations, as needed. Completes analysis and communicates trends in errors or documentation concerns to the Director of Coding Compliance & Revenue Integrity. Participates in industry-related webinars and/or other conference calls, as needed, and summarizes information for team and for educational awareness messaging. Offers recommendations for CMS programs enhancement. Monitor activities of team members; provide feedback and counsel team members regarding performance. Ensures compliance with local, state, and federal government requirements. Assist with department tasks, as needed. Facilitate and lead projects to monitor and audit the performance of the Compliance Program and related activities on a continuing basis and in a collaborative and facilitative manner, ensuring goals of common stakeholders are met. Manages incident tracking process including documenting investigations, overseeing corrective action plans, creating toolkits to use in analysis, and reporting outcomes. Continually improve a centralized system for tracking incidents. Manages the monthly review of OIG Workplan updates to ensure alignment. Act as a steward by exhibiting sound ethical standards and consistently promoting a compliant culture. Research and author educational materials. Participate in Compliance Team Projects and initiatives when requested. Develop expertise and perform research in compliance subjects and issues when requested. Required Experience and Competencies Bachelor’s degree in Business Administration, Healthcare, or related field desired Required. Minimum 5+ years of health care compliance experience or equivalent field required. Knowledge of and ability to apply Compliance policies, practices, systems, and standards required. Experience in the application of CMS Quality Program measures highly desired required. Certified Procedural Coder (CPC certification, or equivalent, and/or Certification in Healthcare Compliance (CHC) preferred. Ability to manage multiple tasks in a fast-paced, collaborative cross-functional environment. Ability to remain organized and effectively manage competing priorities while meeting deadlines. High attention to detail. Ability to analyze new or ambiguous information, define the issue or problem, and project plan the resolution. Ability to use analytical and creative problem-solving skills. Ability to strike a balance between showing initiative and seeking appropriate guidance and input from others. Excellent interpersonal skills, including conflict resolution. Ability to effectively communicate orally and written. Ability to use multiple Vituity systems and understand their connections and impact. Advanced proficiency in Microsoft O365 (Word, Excel, Outlook, SharePoint and PowerPoint). Knowledge of Health Information Management principles, policies and procedures. Knowledge of compliance principles, including Office of Inspector General Seven Elements. Knowledge of Healthcare systems, health plans, and/or physician groups. Knowledge of pathology and etiology of disease, body areas and organ systems Knowledge of CPT and ICD-10-CM coding practices and/or knowledge of Medicare/Medicaid billing practices and appeal process. Knowledge of Health Insurance Portability & Accountability Act (HIPAA), Fraud Waste & Abuse, and Emergency Medical Treatment and Active Labor Act (EMTALA). Knowledge of Medicare and Medicaid guidelines The Community Even when you are working remotely, you are an important part of the Vituity Community. We offer plenty of opportunities to engage with other Vitans through a variety of virtual meet-and-greets, events and seminars. Monthly wellness events and programs such as yoga, HIIT classes, and more Trainings to help support and advance your professional growth Team building activities such as virtual scavenger hunts and holiday celebrations Flexible work hours Opportunities to attend Vituity community events including LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more Benefits & Beyond* Vituity cares about the whole you. With our comprehensive compensation and benefits package, we are mindful of what matters most, and support your needs of today and your plans for the future. Superior health plan options Dental, Vision, HSA/FSA, Life and AD&D coverage, and more Top Tier 401(k) retirement savings plans that offers a $1.20 match for every dollar up to 6%25 plus discretionary profit-sharing contributions (eligible January following 18 months of service) Generous paid time off starting 3-4 weeks’ annually Student Loan Refinancing Discounts Professional and Career Development Program EAP and travel assistance included Wellness program Purpose-driven culture focused on improving the lives of our patients, communities, and employees We are excited to share the base salary range for this position is $85,170 - $106,465, exclusive of fringe benefits or potential bonuses. This position is also eligible to participate in our annual corporate Success Sharing bonus program, which is based on the company’s annual performance. If you are hired at Vituity, your final base salary compensation will be determined based on factors such as skills, education, and/or experience. We believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please speak with a recruiter for more details. We are unified around the common purpose of transforming healthcare to improve lives and we believe everyone has a role to play in that. When we work together across sites and specialties as an integrated healthcare team, we exceed the expectations of our patients and the hospitals and clinics we work in. If you are looking to make a difference, from clinical to corporate, Vituity is the place to do it. Come grow with us. Vituity does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Vituity is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. *Benefits for part-time and per diem vary. Please speak to a recruiter for more information. Applicants only. No agencies please. Apply To This Job