Senior Manager, Program Integrity – CPC, RHIT, RHIA required
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Job Description
Senior Manager, Program Integrity managing medical record auditing and regulatory compliance processes. Leading team efforts to enhance auditing outcomes and operational efficiency.
Responsibilities:
- Implement optimization opportunities for prepay and post pay medical record auditing procedures and processes improvement auditing timeliness and quality outcomes
- Oversee and ensure that supporting business and regulatory processes and documentation exists and kept current
- Track and communicate production issues and escalations to ensure proper follow-up and coordination
- Maintain project plans for all projects in which configuration is involved and ensure proper completion of those plans and escalation where timeframes will be changed
- Lead new product and new vendor implementations to ensure timeliness and quality of new implementations
- Develop and implement ticket controls and ensure that proper communication and approvals are in place prior to system implementation
- Oversight and management of team of medical record coding auditors
- Analyze and make a determination of appropriate reimbursements and/or modifications of Coding review guidelines in partnership with medical directors and clinical staff.
Requirements:
- Bachelor’s degree or equivalent years of relevant work experience is required
- Minimum of five (5) years of experience in medical policy is required
- Minimum of five (5) years of management experience is required
- Health plan experience is required
- Facets and clinical editing system or equivalent system experience is required
- Advanced computer skills and abilities in Facets
- Proficient in Microsoft Suite to include, Word, Excel, and Access
- Knowledge of regulatory reporting and compliance requirements
Benefits:
- Bonuses tied to company and individual performance
- Substantial and comprehensive total rewards package
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