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Compliance Manager - Medicare

Denver, CO · Accounting/Finance
Position Overview: 
The company's Compliance department, identifies, develops, and implements strategies to mitigate risk in a quickly evolving healthcare regulatory landscape.  As a Compliance Manager, you will join a team of highly motivated individuals and will be a key player in enhancing compliance oversight. This position will provide compliance guidance and support to the company's Revenue Operations functions and teams on compliance related matters, including but not limited to, federal and state billing regulations and laws and other healthcare regulatory requirements that arise in the context of dialysis billing.  This position will liaise between Revenue Operations, legal, and compliance to ensure False Claim Act and other fraud and abuse risks are mitigated.

  • Reports to Compliance Director.
  • Manages day-to-day compliance program for Revenue Operations for dialysis business unit including, but not limited to the following departments: Government Payer Alliance, Patient Resources, Collections, Medical Coding, and other supporting teams.
  • Member of Revenue Operations Policy & Procedure committee supporting and providing compliance guidance on revenue operation related policies.
  • Supports Director with compliance special projects related to Revenue Operations.
  • Ensures compliance with and maintains a working knowledge of the False Claims Act, Federal and State regulations and rules as set forth by the Center for Medicare and Medicaid Services (CMS), as well as other laws and regulations related to healthcare revenue cycle.
  • Identifies potential revenue cycle compliance vulnerabilities through various methods, including risk assessment and ongoing monitoring.
  • Creates and manages annual work plans to address identified risks and supports annual audits.
  • Partners and collaborates with revenue operations leadership and legal counsel to develop and provide guidance on billing-related compliance questions and issues.
  • Demonstrates strong analytical skills and follow through the ability to seek to understand underlying assumptions through probing, questioning, listening, and problem solving.
  • Manages and leads multiple projects concurrently, meets deadlines, and adjusts priorities appropriately in a high paced work environment.
  • Effectively communicates to and educates revenue operations partners on complex matters.
  • Demonstrates an aptitude for critical thinking in complex situations and an ability to synthesize ambiguous data into concrete insights.
  • Leads and/or participates in projects related to the design, implementation, revision or maintenance of processes and systems that promote compliance related to the revenue cycle.

  • Bachelor’s degree required; JD/MBA/CPA/CHC or other relevant advanced degree or certifications preferred
  • Minimum 5 years’ experience as a legal or compliance professional responsible for the development, implementation, and/or sustaining of an effective compliance program
  • Preferred experience in healthcare or pharmaceutical industries dealing with federal healthcare billing laws and requirements including, but not limited to False Claims Act, Fraud Waste and Abuse, and Beneficiary Inducement
  • Preferred experience in healthcare reimbursement and revenue cycle management
  • Preferred working knowledge of Medicare Claims Processing Manual and Medicare Benefits Policy Manual
  • Preferred experience or knowledge in Policy & Procedure best practices
  • Experience in positively and successfully managing relationships with a high energy and diverse group of leaders across organizational lines
  • Strong organizational and project management skills with demonstrated attention to detail
  • Strong technology skills, including Microsoft Office (e.g., Outlook, Word, Excel, PowerPoint, Visio)
  • Must be a self-motivated, team player with proven ability to identify issues and manage priorities in fast paced environment while striving for practical business solutions
  • A thoughtful, articulate, and effective communicator who can distill and articulate the important aspects of any issue to a wide audience of participants
  • Superior written and verbal communication skills (including presentations), and the ability to drive execution in a team environment
  • Hands on, efficient and proven ability to “Get Stuff Done” with a bias for action and a strong sense of ownership.
  • We are open to out of state candidates.
Kat Forester
ProEnlist, LLC

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