- Maintains an in-depth and ongoing understanding of industry related compliance requirements, issues, coding updates, regulatory changes, and industry related best practices.
- Assures OCB's Compliance Program is aligned with regulatory and Practice requirements by developing, implementing, monitoring, and maintaining policies, procedures, and programs to support ongoing activities and requirements of compliance program.
- Coordinates and delivers educational training programs consisting of appropriate documentation guidelines, and accurate coding to all appropriate personnel including coding staff, scribes, clinical managers and technicians, physicians/providers, and billing personnel.
- Perform internal audits and compliance reviews, identifying, escalating, resolving, and managing requirements and issues in timely and proactive manner.
- Conduct regular coding audits and coordinate the monitoring of coding and documentation accuracy, reviewing claim denials and rejections pertaining to coding and medical necessity issues.
- Proactively identifies less-apparent coding issues and red flags, by monitoring data, reporting, and procedures/practices to anticipate the obvious and most complex of coding issues; continuously mitigating risks by escalating as needed and recommending remedies.
- Collect, analyze, interpret, and document information to support audit findings, present to all levels of management and providers regarding findings and recommendations.
- When necessary, assist in the implementation of corrective action plans, such as educational programs to prevent similar denials and rejections from recurring.
- Receive, investigate, and report on compliance complaints and "hotline" reports.
- Evaluate adequacy of managements and providers response to recommendations cited, provide feedback and reporting as needed and required.
- Conduct annual audits as it relates to regulatory agencies assuring adherence to regulatory requirements.
- Report non-compliance issues detected through auditing and monitoring, create corrective action plans and results of follow-up audits to the VP of Operations and Senior Management.
- Maintain ongoing knowledge of coding, regulations, and compliance/regulatory agencies.
- Serves as patient advocate, addressing and managing escalated patient concerns.
- Provide research and support for special projects.
- Minimum of five to seven years of physician billing/auditing experience. Experience as a clinical technician in ophthalmology practice preferred.
- Extensive knowledge of CPT coding principles, guidelines and practices is required.
- Experience with performing physician compliance reviews of healthcare institutions especially subspecialties, ideally in an ophthalmic setting.
- Strong knowledge base in complete and accurate clinical documentation
- Knowledge of electronic medical records and practice management software
- Minimum of 5 years of medical auditing in a health care setting, progressive experience in out-patient coding and billing preferred.
- Strong knowledge of Federal (HIPPA) and State health care regulations, standards, policies and requirements pertaining to documentation, coding and billing.
- The ability to accurately interpret and implement regulatory standards and legal requirements
- Strong analytical and problem-solving skills and proficient in report writing and oral communications
- Ability to influence, push-back and hold accountable in a professional and diplomatic manner.
- Strong professional attitude and demonstrated ability to communicate effectively with all levels of management and personnel.
- Highly organized with ability to multi-task and prioritize
- Ability to establish and maintain effective working relationships with patients and staff members.
- Strong computer skills
- Bachelor's degree, or equivalent experience. Masters preferred.
- Ability to travel to various offices
- Health & Dental Insurance- eligible 1st day of employment
- Paid time off and paid holidays
- Health & Dependent Reimbursement Accounts
- 401(k) Plan with company contribution
- Company paid Life and LTD Insurance
- Employee discounts
-
Compliance Manager
3 days ago
Peabody Properties, Inc. Braintree, United StatesPeabody Properties, Inc. is seeking an experienced Compliance Manager to join its growing Compliance Team · The Compliance Manager works in conjunction with Operations and other departments as business needs demand to ensure full compliance with affordable housing requirements of ...
-
Compliance Manager
1 week ago
Peabody Properties, Inc. Braintree, United StatesPeabody Properties, Inc. is seeking an experienced Lease-Up Compliance Manager is responsible for the successful completion of affordable and/or mixed income community rent up, from initial marketing through completion of investor reporting and beyond as may be necessary. · **Fun ...
-
Ethics & Compliance Manager
5 days ago
Lantheus Medical Imaging Inc Bedford, United StatesLantheus is headquartered in Bedford, Massachusetts with offices in New Jersey, Canada, and Sweden. For more than 60 years, Lantheus has been instrumental in pioneering the field of medical imaging and has helped physicians enhance patient care with its broad product portfolio. · ...
-
Healthcare Compliance Manager
1 week ago
Ophthalmic Consultants Of Boston Plymouth, United StatesOCB is currently seeking a Healthcare Compliance Manager. They will be based out of our Plymouth office and travel to other offices as necessary. The ideal candidate will have prior clinical experience, successfully worked across all levels of an Ophthalmic, sub-specialty or gene ...
-
beBee Handyman Kongiganak, AK, United States FreelanceI am in need of advice for a small business with only one employee in Kongiganak, AK. I am looking for a fiscal and/or tax advisor (taxes, income, etc.) on a continuous basis (monthly or quarterly) for an independent client. The business has been active for 2-5 years and has 1 em ...
-
Quality Compliance Manager
2 weeks ago
EMD Serono, Inc. Rockland, United StatesQuality Compliance Manager · 100% onsite in MA · Pay: $60.00 an hour · Bachelor's degree with a minimum of 3 years in a quality and compliance role (Pharmacovigilance) · Possible contract to hire opportunity · Description · The focus for this position is coordinating, managin ...
-
Senior Manager, Compliance
6 days ago
Cellares Bridgewater, United StatesSenior Manager, Compliance & Quality Systems · We are seeking an innovative and highly motivated Senior Manager, Compliance & Quality Systems, who will contribute significantly to the growth of the Cellares team. · This individual will be responsible for implementing and managin ...
-
Senior Manager, Compliance
1 week ago
Tufts Health Plan Canton, United StatesSenior Manager, Compliance page is loaded · Senior Manager, Compliance · Apply · remote type · Hybrid · locations · Canton, MA · time type · Full time · posted on · Posted 3 Days Ago · job requisition id · R7665 · Who We Are · Point32Health is a leading health and we ...
-
Senior Manager, Compliance
20 hours ago
Cellares Bridgewater, United StatesWe are seeking an innovative and highly motivated Senior Manager, Compliance & Quality Systems, who will contribute significantly to the growth of the Cellares team. · This individual will be responsible for implementing and managing the site Quality Systems, Supplier Quality, T ...
-
Trade Compliance Manager
1 week ago
Philips Plymouth, United States Full timeJob Title · Trade Compliance ManagerJob Description · You are a part of a team that is at the core of ensuring that we meet Philips' promise to comply with trade and transportation regulations. You will be a key player in securing and optimizing the global goods flow by analysis ...
-
Ethics & Compliance Manager
4 days ago
Lantheus Medical Imaging Inc Bedford, United StatesJob Description · Job DescriptionLantheus is headquartered in Bedford, Massachusetts with offices in New Jersey, Canada, and Sweden. For more than 60 years, Lantheus has been instrumental in pioneering the field of medical imaging and has helped physicians enhance patient care wi ...
-
Quantum Ventures Green Harbor, United StatesPosition: Head of Legal · Location: Berlin, Germany (Remote - Monthly travel to Berlin) · Company Overview: Green Harbor is a dynamic and innovative technology company based in Berlin, Germany. We are leading the way in revolutionizing the technology industry and our mission is t ...
-
Ethics & Compliance Senior Manager
1 week ago
Brother International Corporation Bridgewater, United StatesThe Senior Manager, Ethics & Compliance has responsibility for investigating allegations of violations of Company policy, our Code of Conduct, and other internal matters which may be confidential or sensitive, including disclosures for potential conf Manager, Senior, Compliance, ...
-
Ethics & Compliance Senior Manager
1 week ago
Brother Industries Bridgewater, United StatesLet's Grow Together · Our mission is to live our "at your side" promise and simplify and enrich the lives of our customers, employees, and communities. "At your side" is more than a slogan to us; it's the purpose we do our best to fulfill every day. With a legacy spanning over a ...
-
Ethics & Compliance Senior Manager
5 days ago
Brother Bridgewater, United StatesLet's Grow Together · Our mission is to live our "at your side" promise and simplify and enrich the lives of our customers, employees, and communities. "At your side" is more than a slogan to us; it's the purpose we do our best to fulfill every day. With a legacy spanning over a ...
-
Manager, Quality Assurance/Compliance
2 weeks ago
Integra LifeSciences Mansfield, United StatesChanging lives. Building Careers. · Joining us is a chance for you to do important work that creates change and shapes the future of healthcare. Thinking differently is what we do best. To us, change equals opportunity. Every day, more than 4,000 of us are challenging what's pos ...
-
Human Resource Generalist
1 day ago
Current Lighting Employee Co LLC Plympton, United StatesCurrent (formerly GE Current, a Daintree Company) has unveiled a new brand identity following the historic acquisition of Hubbell's Commercial & Industrial (C&I) Lighting business. The enterprise brand unites the companies under a single identity with one purpose: To deliver the ...
-
Manager FP&A Contracts and Compliance
6 days ago
Abbott Laboratories Plymouth, United States Full timeManager FP&A Contracts and Compliance · Working at Abbott · At Abbott, you can do work that matters, grow, and learn, care for yourself and family, be your true self and live a full life. You'll also have access to: · Career development with an international company where you can ...
-
Manager FP&A Contracts And Compliance
1 week ago
Abbott Plymouth, United States Full timeAbbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medic ...
-
Welder (m/f/d) in day shift in Kraichtal
1 week ago
Skyline Solutions New Marshfield, United StatesWe are Trio Personalmanagement - your regional personnel service provider. · Our entire management team, employees, and staff bring years of experience in temporary staffing, recruitment, sales, customer service, recruiting, and employee care, and are dedicated to their work with ...
Healthcare Compliance Manager - Plymouth, United States - Ophthalmic Consultants of Boston
Description
Job Description
Job DescriptionOCB is currently seeking a Healthcare Compliance Manager. They will be based out of our Plymouth office and travel to other offices as necessary. The ideal candidate will have prior clinical experience, successfully worked across all levels of an Ophthalmic, sub-specialty or general medical practice, with significant experience and exposure to compliance, billing, and coding practices. Understands, practices, and maintains superior diplomacy, conflict resolution, and problem-solving skills. He/she is exceptionally detailed oriented and has demonstrated the ability to educate and manage employees at all levels of an organization.
Position Overview:
This "hands-on" role is responsible for designing, developing, implementing, supervising, and reviewing internal policies, procedures, processes, and practices to assure all patient coding and documentation is accurately interpreted, captured, and managed in accordance with regulatory and Practice requirements. Works across the practice and entities with providers, clinical managers, technicians, scribes, and billing personnel to educate, train, audit, research, investigate, problem solve and resolve compliance related requirements and issues; mitigating risks and reinforcing required practices to assure best practices are implemented and maintained throughout the Practice and its affiliates.
Responsibilities include:
Education, Experience and Skills:
Benefits Offered:
To find out more about OCB, please visit our website at OCB is an Equal Opportunity Employer
Powered by JazzHR
IaBHu2XFJp
Healthcare Compliance Manager professionals in Plymouth
-
Glenn Graunas
Major in Allied Health Sciences with a concentration in Healthcare Administration.