Responsible for ensuring that patient billing, coding, and collection practices adhere to all relevant federal, state, and local healthcare regulations. This role is vital for mitigating financial risks, preventing legal penalties, and maintaining the organization's financial health.

Primary duties and responsibilities:

- Policy and program development: Designs, implements, and manages the organization's revenue cycle compliance program. This includes creating and updating policies and procedures related to patient billing, coding, and documentation.

- Risk assessment: Conducts regular risk assessments to identify potential vulnerabilities within the revenue cycle. This involves analyzing processes related to patient intake, charge capture, and account receivables to detect potential issues before they lead to violations.

- Auditing and monitoring: Oversees and conducts internal audits of billing records and medical documentation to ensure compliance with payer requirements, such as Medicare, Medicaid, and private insurers. They also review data for improper coding, modifiers, and documentation standards.

- Training and education: Develops and delivers compliance training programs for staff, including billing and coding specialists, as well as clinical and administrative teams. This ensures employees are up to date on regulatory changes and best practices.

- Investigating issues: Investigates reported or discovered compliance issues, documenting findings, and reporting potential violations to leadership. They may also work with human resources to determine appropriate disciplinary action for non-compliance.

- Regulatory communication: Acts as the primary liaison with external regulatory bodies and government agencies, responding to inquiries, audits, and investigations.

- Corrective action: Develops and tracks corrective action plans to address compliance deficiencies, following up with management to ensure successful implementation.

- Reporting: Creates and presents periodic compliance reports to leadership detailing auditing activities, findings, risk levels, and the status of corrective actions.

- Follow up of the quality & ISMS audits and actions Conduct/formulate/co-ordinate training programs and feedback actions related to ISO 27001:2005

- Research and recommend centralized written manuals and procedures regarding security controls & HIPAA Controls.

Key qualifications and skills

- Healthcare Management Proficiency

- Regulatory knowledge: In-depth knowledge of healthcare regulations and laws, including HIPAA, CMS guidelines, and state-specific billing requirements.

- Coding expertise: Advanced knowledge of medical coding, including CPT, HCPCS, and ICD-10.

- Analytical skills: The ability to analyze complex data sets from audits and financial reports to identify trends, pinpoint issues, and generate actionable insights.

- Communication skills: Excellent written and verbal communication to explain complex regulatory information, create clear policies, and report findings to various stakeholders, from billing staff to senior leadership.

- Leadership: The ability to lead teams and influence cross-functional departments to adopt and maintain a culture of compliance.

- Attention to detail: A keen eye for detail is essential for reviewing documentation, policies, and regulations to ensure all requirements are met.