Job Summary

​Provides direction and oversight for billing and coding compliance related activities of Revenue Cycle. Specifically manages the audits of practitioner coding and documentation and performs coding audits in support of Geisinger’s Corporate Compliance Plan. Manages the responses to all audits performed by governmental and commercial third-party payers. Manages regulatory audits. Additionally, provides analysis and recommendations on billing and compliance issues. Provides oversight for the team responsible for the objective appraisal and evaluation of Revenue Management’s system of internal controls with special focus on those that have been designated as key controls. The team maintains the narrative of the revenue cycle and provides and performs audits and internal control assessments on an ad hoc basis. Provides oversight for the team responsible reviewing, designing, and implementing processes for security testing and performing regular audits on the role-based user security assignments.

Job Duties

• Manages all operations within the Compliance, Internal Controls and Security Department in conjunction with direction from leadership.

• Provides oversight, direction, and support of staff and all compliance related activities, including Internal Controls and Security Testing.

• Responsible for development, maintenance and implementation of Revenue Management’s Compliance Program.

• Interfaces with all relevant departments to coordinate and monitor consistency with Compliance Program and with applicable regulatory requirements and reports these results to the appropriate leader and administrative departments.

• Expected to be the subject matter expert regarding issues in the field of coding and billing compliance.

• Leads efforts within the organization to promote compliance through education, training, audits, and other means as appropriate.

• Coordinates external audits, including appropriate response and the preparation of operational improvement plans.

• Disseminates information to key stakeholders on a timely basis. Reports compliance activity to various internal compliance committees as needed.

• Responsible as Medicare compliance subject matter expert for understanding all regulatory requirements applicable to the Medicare line of business, and for tracking changes to such requirements.

• With respect to governmental payers, coordinates the development of and oversees the implementation and maintenance of an investigation and remediation process to ensure prompt response to an investigation of any action inconsistent with applicable regulatory requirements.

• Reports the results of internal control testing to leadership and makes recommendations on corrective action plans.

  Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

Education

Bachelor's Degree- (Required), Master's Degree- (Preferred)

Experience

Minimum of 7 years-Related work experience (Required), Minimum of 5 years-Managerial/Supervisory (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.