Strivant Health partners with physician practices to improve revenue cycle operations by optimizing people, processes and technology. We provide best in class Medical Billing, Collections, Call Center, Credentialing and Analytics that are all designed to focus on maximizing our provider clients’ revenue. This allows our client providers to stay focused on the practice of medicine, rather than the business of medicine. We have worked with over 4,000 providers representing 25 different specialties and over 30 technology platforms in our 20+ years of business.

LOCATION: This position is 100% remote working from your home office.

Hours: Monday - Friday, standard business hours

Status: Full-Time, Exempt

Benefits:
Benefits eligible. We offer BCBS plans for health, dental and Vision through EyeMed. We also have company sponsored life Insurance, plus voluntary STD, LTD, critical illness, ID theft, travel insurance, 401(k) and much more. Benefits start the first of the month following your hire date.

Director Compliance - Government Healthcare Payers - REMOTE

The Director of Compliance Government Healthcare Payers directs a broad and comprehensive program that manages medical billing compliance auditing and monitoring, due diligence billing compliance reviews, billing compliance education and corrective action coordination, and external payer program and program integrity audits. The Director of Compliance ensures Strivant Health, and its clients are in compliance with all applicable government medical billing compliance laws, rules and regulations, policies, and procedures. The Director of Compliance leads all government payer compliance strategies, risk assessments, and policies. The Director contributes to the success of Strivant Health's mission and values by minimizing its billing compliance risks and vulnerability to violations of complex state and federal billing laws and regulations.

ESSENTIAL FUNCTIONS:

  • Promotes a culture of compliance and ethics, to ensure quality of services delivered and reduces risk of government audits, fines, penalties, and sanctions.
  • Maintains appropriate liaison with state and federal law enforcement and regulatory agencies and professional compliance associations to assure awareness and early detection and prevention of potential risks and vulnerabilities
  • Designs and implements programs, policies, and practices to ensure that organization complies with state and federal medical billing and coding laws and regulations.
  • Leads government payer billing compliance regulatory strategies, government billing practice recommendations, audits and mitigating Medicare, Medicaid and government state payer program risks
  • Acts as a consultant, investigator, educator, coordinator, and liaison across departments
  • Interacts with executives, management, and client physicians to provide compliance and risk management leadership and oversight.
  • Leads or participates in implementation of regulatory requirements through projects and assignments.
  • Evaluates and identifies risks and supports corrective action plans across service lines
  • Executes vision and strategic priorities. Links day-to-day compliance activities to strategic objectives/priorities.
  • Researches, analyzes, and documents company positions on complex legal issues to support billing compliance requirements
  • Reviews and analyze deliverables and data reports to ensure timeliness of submission and identify trends in performance and improvement opportunities
  • Performs audits and monitors risk assessments and documentation activities to ensure compliance
  • Identifies, investigates, and resolves compliance issues and develop corrective action plans to mitigate future risks
  • Serves as the “go to” person for all compliance activities including training and awareness programs for internal teams
  • Designs, implements and improves regulatory documentation and processes to address compliance issues and concerns related to all federal and state regulatory requirements, contract requirements and company standards
  • Organizes and undertakes reimbursement, coding, and procedural audits and clearly summarize findings and recommendations
  • Works in concert with corporate Officers to define and coordinate compliance strategies and action plans
  • Monitors billing practices and serves as point person for external billing audit activity for program integrity.

REQUIREMENTS:
  • Bachelor’s degree in health care administration, compliance or related field. Master's degree preferred.
  • Certified in Healthcare Compliance (CHC) or comparable coding certification such as RHIA, RHIT, CCS, CCS-P, or CPC with equivalent compliance work experience.
  • At least 5 years’ experience in hospital and/or professional medical practice group billing, revenue cycle, HIM, and coding
  • At least 3 years of direct experience leading government payer medical billing compliance regulatory strategies, billing practice recommendations, audits and mitigating government payer risks, required. This includes handling government payer risk assessments, auditing and reporting processes, action plans, and government billing compliance training.
  • Advanced understanding of CMS Coding Compliance Guidelines, and AMA
  • Understanding of government payers and other commercial/managed care carrier rules and processes in a professional billing environment, inlcuidng prior experience with Medicare and Medicaid billing compliance assessments..
  • Previous experience in reading and interpreting governmental statutes and regulations.
  • Prior experience serving as the expert in healthcare billiing compliance to Executive leadership within an organization
  • Demonstrated proficiency with managing client communications and meeting/exceeding SLAs
  • Proven working knowledge of billing compliance laws and regulations, incluing but not limited to OIG, HIPPA, and fraud, waste and abuse laws.
  • Strong analytical, communication and presentation skills with the ability to work independently.
  • Proven project management skills with a proven ability to manage multiple projects, with varying scopes and duration, involving multiple constituents while effectively meeting deadlines required.
We are looking forward to reviewing your resume!

No agencies, please!

Search tags: Patient Access, Patient Financial Rep, Revenue Cycle, RCM, Accounts Receivables Rep, Patient Account Rep, Patient Service Rep, Account Rep, Medical Coding, Medical Credentialing, Medical Referrals, Medical Billing, Payment Posting, Cash Applications

Job Type: Full-time


@StrivantHealth

Location
Remote
Job Type
Full-Time Regular
Exempt or Non-Exempt?
Exempt
Hours
Standard Business Hours
Scheduled Days
Monday - Friday
Position Id
201498