MUSCP - Compliance Manager

Job Description Summary

Manage Physician Coding and Billing compliance operations for assigned specialties, physicians and staff as established by the MUSC Physicians Compliance Plan and other organizations where MUSC Physicians provides compliance oversight via contract. Provide physician/provider and staff education and serve as a resource to the assigned departments on coding, billing, and regulatory issues.

* This position is not remote; candidate must live within the Tri-County area.

Entity

University Medical Associates (UMA) Only Employees and Financials

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC002046 UMA CORP COMP Compliance CC

Pay Rate Type

Salary

Pay Grade

Health-27

Scheduled Weekly Hours

40

Work Shift

Day (United States of America)

Job Description

40% Auditing

• Complete monthly audits following all MUSCP Compliance procedures and report findings to individual audited, the Physician Liaison, Department Administrator, Chairman or other leaders as directed on a    monthly basis.
• Perform risk-based audits, as needed to ensure compliance, based on, OIG Work Plan issues, New Providers, Level III Providers, Annual Audit Plan, or other criteria established by the CCPO, Senior Manager, Executive Compliance Committee or other party, as applicable.
• Assist the Senior Manager and Corporate Data Manager in the developing the methodology for audits and reports to present findings in a clear concise manner. Responsible for follow up audits to validate resolution of documentation issues and completion of corrective action plans.
• Research Coding and other regulatory issues for clinicians and care team members. Respond to concerns and allegations and work with CCPO or Sr. Manager to develop corrective action plans and follow up appropriate to the issues identified.

40% Education

• Assist in the development and deployment of educational/training materials and campaigns; communicates proactively extensively throughout the system to provide education on compliance matters including but not limited to coding guidelines, billing, documentation and reimbursement, Teaching Physician Regulations, and scope of practice.
• Responsible for entering all education sessions into designated system per departmental instructions.
• Responsible for onboarding all new billing providers through one-on-one education within 30 days of start date.

20% Other Job Duties

• Collaborate with Regulatory Manager to prepare assigned area summary for Annual Compliance Report.
• Attend all Departmental Compliance meetings, department, division, clinic, or faculty meetings as requested.
• Works closely with clinicians and EMR technical staff in providing assistance and recommendations of EHR templates and other standardized documentation formats.
• Participate in monthly MUSC Physician Compliance Proficiency training as directed by the Senior Managers.
• Participate as requested of the MUSC Physician Compliance Innovation Campaign idea as directed by the Senior Managers.
• Responsible for monitoring and maintaining active and deferred charges within the work queue per departmental instructions.
• Assist Senior Managers & Regulatory Manager in the review of departmental processes, policies, and procedures to ensure material is up to date and promotes greater efficiency.
• Assist Sr. Compliance Managers and CCPO on special projects and other duties assigned.

Additional Job Description

Required Minimum Qualifications and Education:

•  Bachelors and 3 years’ experience or associate degree with 5 years’ experience required. Internal candidates may be considered without a degree based on coding certification and relevant experience.
• Experience educating physicians in group or individual training sessions.
• Demonstrates solid technical knowledge, understanding of business concepts, regulatory rules, and auditing procedures.
• Experience researching coding questions and providing documentation to support coding decisions.
• Extensive knowledge of ICD10, CPT, HCPCS coding and Medical Terminology.
• Excellent communication and interpersonal skills.
• Must maintain credentials through education and stay current on regulatory trends and changes in the law.
• Knowledge of Microsoft Office Applications including Word, Excel, and PowerPoint.
• Experience with and aptitude for using medical billing software.

Required Licensure, Certifications, Registrations: CPC, CCS-P, RHIA, RHIT or other medical coding certification preferred. Candidates without a current coding certification are required to obtain one within 18 months of hire.

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If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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