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Manager Compliance Medical Group

Job ID:
R29934

Shift:
1st

Full/Part Time:
Full_time

Location:

750 W Virginia St
Milwaukee, WI 53204

Benefits Eligible:
Yes

Hours Per Week:
40

Schedule Details/Additional Information:
Salary

Manages the auditing and data analytics component of the medical group compliance program, develops and implements education and training tools, participates in policy and procedure development, and serves as the internal expert on medical group revenue cycle-related compliance matters.

Major Responsibilities:

  • Manages and conducts compliance investigations and resolution of identified compliance concerns and regulatory violations related to the medical group revenue cycle. Works with compliance leadership, medical group and business office leadership and providers to identify, research, define, and resolve compliance issues.
  • Manages audits and investigatory activities in response to external regulatory investigations, surveys, and audits related to medical group revenue cycle compliance issues.
  • Manages the day-to-day internal auditing and monitoring of all employed billing providers, including the use of data analytics to identify aberrant billing and utilization patterns.
  • Manages data analysis for medical group risk assessments as part of the system-wide quarterly compliance risk assessment process.
  • Creates and delivers education and other activities designed to prevent and correct issues related to regulatory compliance and ethical conduct.
  • Participates in the development and implementation of policies and procedures related to compliance and ethical conduct within the medical group.
  • Collaborates with operational departments to achieve compliance with accreditation standards that intersect with regulatory requirements.
  • Serves as internal expert and advisor in compliance matters related to regulations affecting the medical group revenue cycle.
  • Works with Human Resources to investigate suspected caregiver misconduct and to determine appropriate disciplinary action.
  • Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
  • Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.
  • Responsible for understanding and adhering to the Aurora Health Care Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to Aurora's business.

Licensure, Registration and/or Certification Required:

  • Coding Specialist – Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
  • Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC).

Education Required:

  • Bachelor's Degree in Health Information Management or related field.

Experience Required:

  • Typically requires 5 years of experience in physician/medical group revenue cycle compliance. Includes 1 year of supervisory experience in the management of staff, budgets, and compliance functions.

Knowledge, Skills & Abilities Required:

  • Advanced knowledge of ICD, CPT and HCPCS coding guidelines and federal and state health care regulations related to medical group billing.
  • Demonstrated ability to lead a team in a matrix management structure.
  • Excellent organizational and prioritization skills. Strong planning, problem-solving and change management skills.
  • Demonstrated leadership skills and the ability to work and function in a complex corporate system environment.
  • Excellent written and verbal communication skills. Strong skills in personal diplomacy with demonstrated ability to handle sensitive communications with leadership and physicians.
  • Ability to take initiative and work collaboratively with others.
  • Demonstrated ability to function as a mentor, role model and teacher.
  • Demonstrated proficiency in the Microsoft office (Word, Excel, PowerPoint, Access) or similar products, including ability to organize complex information and to prepare spreadsheets and presentation materials.

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