REGIONAL COMPLIANCE OFFICER in LOUISVILLE, Kentucky | Careers at LOUISVILLE, KY 40222 Relevant Educational Qualifications Job2 weeks ago - Other categories - Louisville - 6 views
Compliance and Risk focuses on maintaining compliance and mitigating risk to the organization. If your passion is in quality assurance investigations and compliance adherence, join our team and apply today!
- Identify compliance risk areas within multiple states, payor sources and regulatory bodies throughout the organization by observation, data analytics and research of existing and emerging regulatory trends
- Recommends and monitors system-wide programs, policies and procedures to ensure system compliance, including implementation of CMS and governmental billing regulations - particular emphasis on Medicaid funded programs (such as Home and Community Based Waivers or Intermediate Care Facilities) and behavioral health programs
- Develop and implement audit tools to identify risk based upon risk assessment, regulation and policy
- Conducts independent field and desk compliance reviews/audits to investigate and monitor compliance with standards and procedures implemented by the Company and duties imposed by state and federal agencies
- Identify documentation issues that impact billing and coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to documentation issues.
- Analyze findings to identify discreet or systemic compliance issues across agency, state, region, business line or payor source
- Create clear and accurate audit findings and recommendations in written audit reports that will be used for advising and stakeholders throughout the organization
- Manage the results of corrective action plans on completed audits
- Works with health information management, revenue cycle staff, and information system staff to analyze and implement solutions to maintain compliance in revenue cycle activities
- Evaluates IT billing systems for potential compliance problems and non-compliant activities
- Provides timely and relevant analysis and recommendations to operational leadership on all aspects of compliance issues
- Research and Maintains awareness of laws and regulations, keeping abreast of current changes that may affect skilled health care systems through personal initiative, seminars, training programs and peer contact
- Investigate complaints and concerns or questions relative to compliance issues.
- Reviews complaints, concerns or questions relative to compliance issues and provides consultative leadership and support to all entities as appropriate
- Special projects as needed by the Company, including educational programs, development of compliance policies, and special audits or investigations
- Other duties as assigned
- Bachelors degree required; Masters or other advanced degree is preferred in a related field (health care administration, finance, CPA, etc.)
- Five years progressive experience in Billing Compliance, Revenue Integrity and/or health information management is required. Significant Medicaid billing experience required
- Certification in Health Care Compliance (CHC) preferred
- Experience in the home and community based, Intellectual Developmental Disabilities (IDD) and/or health services field preferred
- Healthcare regulatory language analysis and interpretation
- Knowledge of IT system impact, use, function and design relative to coding, billing and reimbursement
- Knowledge of various compliance rules and regulations in coding, billing and revenue cycle areas and of the various sources and resources for information at the federal, state and local level in the compliance area
- Extensive knowledge of the various payment systems
- Must be able to demonstrate appropriate conflict resolution in stressful situations
About our Line of Business
BrightSpring Health Services is the leading provider of complementary pharmacy, and comprehensive home and community-based health services for complex populations in need of specialized care. Through the company's eleven lines of business including home care, hospice, community living, behavioral health, family and youth, pharmacy, neuro rehabilitation, home health, applied behavior analysis and workforce development, the focus is on providing comprehensive care services, specialized care and clinical services to patients nationwide. For more information, visit (please use the apply button below). Follow us on Facebook, Twitter and LinkedIn.
The company is the leading provider of diversified home and community-based health and pharmacy services to medically complex and high-need populations. Its primary businesses include: behavioral health (including autism services), home health care (including personal care, home health, and hospice), neuro therapy, and job placement and vocational training, supported by pharmacy and telecare ancillary technologies and services. These businesses employ over 50,000 dedicated team members in 50 states and provide services for over 350,000 people every day.