Compliance Manager - Medical Group

Saint Louis, MO

Job Description

Additional Information About the Role

Do you have Outpatient Coding experience? BJC is seeking an experienced people leader to join our Medical Group Compliance team. The Compliance Manager will be the subject matter expert and assist the team with audits, disputes, etc. This is a dynamic and hands on role where your expertise and leadership skills will be fully utilized.

• Full-Time; benefits eligible!
• Monday - Friday; days only!
• Hybrid position! Primarily work from home with occasional onsite meetings, so must be within driving distance to St Louis Metro area. The first month may be in person for training at our Mason Ridge location in West County.
• All candidates must have 5-10 years of outpatient coding and auditing experience, a previous history of Professional Evaluation and Management visits and procedures, at least 5 years of leadership experience, a Bachelor's Degree, and a CCS/CPC certification to be considered.

Overview

BJC Medical Group is the multi-specialty physician-led organization of BJC HealthCare and includes over 600 doctors and advanced practice providers who are affiliated with top-ranked hospitals in the Midwest region.

Since 1994, BJC Medical Group has provided access to extraordinary care in over 145 locations and over 25 specialties in the greater St. Louis, mid-Missouri and southern Illinois areas. Our providers are nationally recognized for excellent patient satisfaction, quality health care, and improving the health and well-being of the communities we serve.

The Quality and Compliance Department provides support to the strategic and operational objectives of BJC Medical Group practices is located in Town & Country, MO.

Preferred Qualifications

Role Purpose

Provide expert direction and leadership to the physicians and staff, senior leadership, medical director and serve as the Compliance liaison to the Corporate Compliance Department by personally performing, or supervising others who may perform, the following: (a) developing and monitoring systems for identifying potential compliance matters or possible violations of BJC policies, (b) serving as a contact for compliance questions from BJC affiliates, as well as conducting, coordinating and overseeing compliance investigations and audits, (c) developing, monitoring, updating and disseminating compliance policies and procedures as well as BJC training and education programs and materials, and (d) monitoring Federal and State statutory and regulatory developments and to ensure system compliance with HIPAA, OSHA, Recovery Audit Contractors (RAC), coding and documentation, billing and reimbursement, and charge/pricing compliance. Responsible for assisting in credentialing process, pay for performance structures, and reviewing system-wide coding, billing and documentation practices in accordance with ICD-10-CM, CPT-4 and HCPS coding standards and Medicare regulations

Responsibilities

• Interacts with primary care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation based on the review.
• Leads and manages investigations and audits routinely scheduled reviews of BJCMG providers’ documentation involved with professional fee billing for accuracy of coding, completeness of coding and physical presence. Reviews consist of ambulatory E&M services and office procedures, as well as hospital admissions, subsequent visits, hospital procedures, and all other services performed or supervised by BJCMG providers. Reviews staff reports of findings prior to provider presentation to ensure accurate coding practices and compliance policies are maintained.
• Manages compliance staff to identify under-coded and up-coded services; monitors trends and develops provider education and training on accurate coding practices and compliance issues. Trains compliance staff and conducts proficiency assessments of each staff member annually.
• Manages individuals that design and deliver training instructions and technical support to providers and coders, as appropriate, regarding coding compliance documentation, regulatory provisions, and third party payer requirements.
• Responsible for activities related to protecting the use, disclosure and request for personally identifiable protected health information; development and provision of education and training initiatives to support HIPAA compliance.; monitoring and evaluating HIPAA compliance across BJCMG and AOD database.
• Designs performance measurements and statistical reporting to support the strategic plan and assesses clinical and operational performance.
• Manages individual(s) including but not limited to: onboarding and hiring, training, workload management & performance evaluations, conducting professional development plans as needed. Ensures that the productivity and actions of that group meet/support the overall operational goals of the department as established by department leadership.

Minimum Requirements

Education

• Associate's Degree
• - Business/HC Admin/related

Experience

• 5-10 years

Supervisor Experience

• 5-10 years

Licenses & Certifications

• CCS/CPC

Preferred Requirements

Education

• Bachelor's Degree
• - Business/HC Admin/related

Licenses & Certifications

• RHIA/RHIT

Benefits and Legal Statement

BJC Total Rewards

At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.

• Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date
• Disability insurance* paid for by BJC
• Pension Plan*/403(b) Plan funded by BJC
• 401(k) plan with BJC match
• Tuition Assistance available on first day
• BJC Institute for Learning and Development
• Health Care and Dependent Care Flexible Spending Accounts
• Paid Time Off benefit combines vacation, sick days, holidays and personal time
• Adoption assistance

To learn more, go to www.bjctotalrewards.com/Benefits

*Not all benefits apply to all jobs

The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job.

Equal Opportunity Employer

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift

Application Question(s):

• A history of professional evaluation and management visits and procedures

Education:

• Bachelor's (Required)

Experience:

• outpatient coding and auditing in a compliance setting: 5 years (Required)
• Leadership: 5 years (Required)

License/Certification:

• CCS AND CPC certifications (Required)

Ability to Relocate:

• St. Louis, MO: Relocate before starting work (Required)

Work Location: On the road