The Compliance Billing Specialist is responsible for supporting the Compliance Department, with a strong focus on communicating the pillars of our Compliance Program across our organization and providing support and recommendations for Compliance Program enhancements. Executes the day-to-day operations of the Compliance Department with a focus of billing audit support, including supporting Operating Groups and Corporate Functions with interpretation and execution of Compliance Program requirements.
ESSENTIAL JOB FUNCTIONS
To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below.
- Supports communication of the Company’s Compliance program, including applicable healthcare laws and regulations, company values, and standards, and helps promote a culture of compliance.
- Drafts communications on important aspects of the compliance program, and instills a culture within the Company through communication of health care laws, applicable regulations, our Company values and standards, as applicable.
- Monitors regulatory changes affecting compliance, privacy and billing areas across assigned service lines; communicates relevant changes and partners with operating groups and Corporate functions on implementations.
- Assists with compliance audits in billing areas as well as investigations. Participation may include:
◦ Partnering with Corporate Functions, which may include Internal Audit, Human Resources (“HR”) and Quality Improvement (“QI”) ◦ Interviewing internal and/or external, staff, and other appropriate individuals ◦ Preparing investigatory reporting and analysis of billing audit results ◦ Providing appropriate recommendations or proposals
- Supports the Compliance Department with billing auditing and monitoring corrective actions following compliance audits or other remedial actions as necessary.
- Participates in the development and delivery of annual Compliance education materials on identified billing topics. Supports on-time completions by generating and delivering completion reports
- Support auditors with assistance in mitigating complex billing and compliance issues and providing support to compliance initiatives.
- Assists the Compliance Department and relative business partners in implementing policies, processes and monitoring systems in an effort to remain compliant and avoid recurrence of findings.
- Participates in the periodic review and update of the Sevita Code of Conduct, Compliance program policies, procedures, and training, to support continuing relevance in providing guidance to management and employees. Supports on-time review requirements of billing by generating and delivering timely reports. Effectively partners for review completions within the audit team and across the organization.
- Ability to research and apply company billing policies, payer requirements and applicable laws and regulations when conducting audits.
- In collaboration with Compliance Department staff, performs internal compliance reviews, compliance risk assessments and related risk activities monitors internal and external regulatory or compliance program standards by creating and reviewing compliance audit reports, including maintaining documented processes.
- Collaborates with other disciplines to perform targeted compliance activities related to audits and specific to billing compliance, as needed.
- Performs other related duties and activities as required.
SUPERVISORY RESPONSIBILITIES
- None
Minimum Knowledge and Skills required for the Job The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job.
Education and Experience:
- Bachelor degree in healthcare administration, business, accounting, or a related field
- 2 – 5 years of related experience; three or more years of healthcare billing, claims or revenue-cycle experience
- Experience reviewing claims for accuracy, researching billing requirements, documenting findings, and support corrective actions preferred.
- Familiarity with Medicaid or other government funded healthcare programs is preferred
Certificates, Licenses, and Registrations:
• N/A
Other Skills and Abilities:
- Ability to maintain confidentiality and comply with applicable privacy and security requirements, including HIPAA.
- High integrity and strong organizational skills, ability to prioritize, manage multiple assignments, track and follow-up on audit related projects.
- Strong verbal and written communication skills.
- Interpersonal skills to handle sensitive and confidential matters.
- Ability to work independently and take initiative where appropriate.
- Ability to read complex regulations and regulatory requirements.
- Ability to produce accurate work in a fast-paced environment and respond constructively to criticism or conflict.
- Ability to partner, lead, coordinate and work through complex issues with strategic, tactical, and fresh perspective.
- Ability to analyze complex billing issues and systems, coordinate and provide support to audit team members and identify practical solutions using strategic and operational perspectives.
- Ability to navigate complex billing systems and review data across platforms to identify discrepancies, trends and potential compliance concerns
Other Requirements:
- Travel as required and may vary, up to 25%
- Prior compliance, legal, regulatory, policy development, experience preferred.
Physical Requirements:
- Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
The regular working hours for this position can be performed remotely; however, due to current business and employment requirements, we are unable to employ individuals in this role who will be working from Alaska, Hawaii, New York, Oregon, South Dakota, Vermont, Washington State, or Washington, D.C. Although the role is primarily remote, occasional in-person and related travel is an essential function of this position.
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face.
We’ve made this our mission for more than 50 years. And today, our 40,000 team members continue to innovate and enhance care for the 50,000 individuals we serve all over the U.S.
As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, citizenship, or any other characteristic protected by law
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