Reimbursement Compliance Manager - Irving, TX #152939

Company: Miraca Life Sciences

Date: 02/17/2017

Category: Health Care

City: Irving, TX

Employment type: Full-time

The Reimbursement Compliance Manager is responsible for leading and overseeing the Revenue and Reimbursement Compliance program for Miraca Life Sciences. This individual serves as an adviser to management about current regulations and performs analysis on proposed changes in regulation. Additionally, the position will maintain all Compliance related Reimbursement policies and provide training in those areas to other members of the team.

Job Responsibilities:

• Manage and oversee the Reimbursement Compliance Program 
• Liaison with Coding to ensure CPT, ICD-10 and HCPCS coding principles, governmental regulations and third party guidelines are documented and/or communicated to appropriate teams 
• Monitors, analyzes, interprets, and communicates regulatory changes related to Reimbursement practices. 
• Ensures compliance with existing rules, new rules, regulations and revisions, as set forth by the Center for Medicare and Medicaid Services (CMS), as well as other federal and state laws and regulations that govern matters related to the Revenue and Reimbursement teams.
• Communicate regulation changes to affected departments, including assembling and chairing work teams, and developing/providing education regarding regulatory requirements.
• Liaison with legal to manage the process for receiving, documenting, tracking, investigating and addressing internal/external complaints regarding regulatory requirements
• Develops and oversees adherence to compliance policies and procedures related to the organization\'s Reimbursement teams
• Develops and manages an annual compliance risk assessment and mitigation plan for the organization’s Reimbursement teams
• Develops and delivers education and supporting tools related to Reimbursement team’s compliance program.
• Serves as internal expert and adviser in compliance matters related to Reimbursement practices
• Report and communicate to department leaders on ongoing monitoring efforts, and any corrective action plans associated with identified deficiencies or trends.

• Bachelor’s degree required in a related field (health care administration, finance, etc.).
• 10 + years progressive experience in healthcare billing compliance, revenue integrity and/or health information management is required. 
• Certification in Health Care Compliance (CHC or CPCO) or relevant experience

 • Knowledge of various compliance rules and regulations in coding, billing and revenue areas and of the various sources and resources for information at the federal, state and local level in the compliance area. 
• Strong understanding of medical terminology, ICD, CPT, and HCPCS coding and medical billing processes.
• Ability to work with all levels of management on potentially complex compliance/regulatory issues
• Strong written skills experience in professional and formal writing of work products such as those required to write and edit policies and procedures, compliance reports, and other communications
• Superior interpersonal communication skills
• Ability to solve problems independently and in a timely manner.
• Must be able to demonstrate appropriate conflict resolution in stressful situations.
• Experience using MS Visio, Word, PowerPoint and Excel


This job description reflects management’s assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.


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