Compliance Program Manager
at Engage Partners, Inc.

Date Posted: 12/4/2019

Job Description


We're seeking a Compliance Program Manager for a FTE opportunity located in Baltimore, MD.

POSITION SUMMARY:
  • This position reports to the Director of Billing Compliance and is responsible for the development, implementation, and ongoing monitoring of the Corporate Compliance Program with a particular emphasis on federal payor billing compliance and compliance related education for the organization and its affiliates.
  • The successful candidate independently assesses a variety of complex compliance risk-areas to develop the Compliance Department's work plan. Responsible for independently performing scheduled audits required by the work plan, unplanned investigations and in carrying out these activities independently providing compliance guidance to personnel. Uses judgment and critical thinking in determining appropriate corrective action for non-compliance as well as ensures that corrective action is taken by the affiliate. Responsible for monitoring and responding to certain regulatory requests and representing the Compliance Department on various committees as requested.
  • Provides regular guidance and advice to personnel, leadership and Executive Management in compliance related areas. Conducts independent research in the areas of Medicare and Medicaid and other complex legal authorities pertaining to billing and regulatory compliance. Responsibilities include the development of education and training for management and staff regarding federal payor regulatory requirements and other compliance matters based on the incumbent's independent judgment of the affiliate's educational needs.
  • Manages audits conducted by vendors and payers and provide regular status reports to senior management. Additionally, the position is responsible for reviewing the draft work product of their peers and to mentor and assist in the training and development of the compliance staff.

COMPETENCIES:

Education:

Requires a minimum of a Bachelor’s degree. A Bachelor’s Degree in Nursing or a Juris Doctor is preferred. Experience beyond the required work experience may be substituted for the degree on a 2 to 1 basis. With every two years’ experience equal to one year of education.

Required Licensure, Certification, Etc.:

For a BSN, requires an active RN license in good standing with the Maryland State Board of Nursing, or another State’s Board.

For a JD, requires an active license to practice law, in good standing, from the Maryland State Board of Law Examiners or another State’s Board.

Work

Job Requirements



Requires a minimum of 5 years medical coding, auditing or related experience. For a JD or other legal professional, experience in healthcare claims, billing, or other health care reimbursement area is required in lieu of medical coding and auditing. For an RN, experience in utilization review or health care reimbursement is preferred.

Knowledge:

A Professional level of knowledge of billing practices and procedures. In depth knowledge in the areas of Medicare, Maryland Medicaid, and commercial insurance billing regulations. Familiarity with the Maryland regulatory environment and other payer methodology is preferred. Knowledge of basic coding and healthcare licensing/accreditation standards is required as is knowledge of other state and federal laws and regulations which affect corporate compliance operations.

Skills:
  • Requires strong interpersonal, oral, and written communication skills; the ability to interact and communicate independently and effectively with all levels of management and staff is essential.
  • Demonstrated ability to research and perform critical analysis of complex billing and compliance law, regulation and policy.
  • Ability to draft documentation of substantial complexity including reports, policies and procedures.
  • Requires the ability to plan and prioritize multiple tasks without supervision.
  • Requires analytical abilities in order to effectively monitor billing and other issues, calculate over and underpayments and report thereon.
  • Requires the ability to prepare and conduct educational presentations.
  • Requires the ability to coordinate audits performed by government and private payers as well as auditors contracted by the organization's entities.
  • Requires ability to make autonomous decisions in assessing and managing compliance risk.


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Job Snapshot

About Us

Join a winning team that gets the job done right. At Engage Partners, Inc., we focus on excellence in the industry of staffing solutions. We work hard every day to get it right and get it done – the right employees, the right businesses, the right time.

There’s a reason why we have been around for decades. Engage Partners, Inc. has a wealth of experience matching people to their prospective employers (and vice versa). We have the ability to provide the opportunity for long-term career paths or temporary project assignments, temporary or full-time positions, executive management recruitment or attracting seasonal assistance. We work with a strong, diverse network of organizations across the country that are always looking for top-notch candidates to fill their open positions. From small business start-ups to Fortune 100 companies, we want your next job to be the one you’ve been waiting for.

We are a full-service staffing agency with opportunities for employment all across the U.S. Our recruitment efforts are focused on professionals in many areas of expertise:

  • Healthcare IT
  • Healthcare / Clinical & Non-Clinical
  • Administrative & Office Professionals
  • Information Technology
  • Sales & Marketing
  • Finance & Accounting
  • Pharmacy
  • Engineering, Energy & Green Technologies

Come see why our clients and our candidates seek out the level of service that makes the Engage Difference: We speak with our clients, not to them. Authoritative and approachable, it's always about the dialogue. Direct and to the point. Let's create solutions, not additional work.

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