Description

PeaceHealth is seeking a full time Program Manager Government Billing Audit position. This remote position requires the incumbent to reside in OR, WA, AK or TX by date of hire.

Responsible for the implementation and management of PeaceHealth's Government Billing Audit Program. Manages the coordination of activities including the timely submission of records along with any related appeals processes; and, working with operational experts as needed to ensure the most comprehensive supporting documents are provided for government billing audits across PeaceHealth.Contributes to the development and maintenance of a compliance program in accordance with the Department of Health and Human Services, Office of Inspector General (OIG), state and local regulations. Implements and oversees an effective compliance program based upon the seven (7) elements. promulgated by the OIG.

What you will enjoy:

Manages the system-wide program for responding to government billing audits and appeals including, but not limited to; RAC, MAC, PERM, CERT, ZPIC, SMRC, QIO, MAC TPE, state Medicaid audits, and others.

Manages all aspects of the program including the timely receipt and submission, communications, appeals, data analytics, and reporting for government billing audits across PeaceHealth.

Serves as the primary PeaceHealth contact for government billing auditors including timely communications; proactive monitoring of external auditor systems/applications; and, proactively reaching out for updates.

Acts as the internal liaison for government billing audits across all levels of PeaceHealth caregivers and leaders including the release of information vendor by communicating all phases of the audit process (such as newly received audits, audit results, and appeals processing) and utilizing subject matter expertise within the organization to ensure the most comprehensive audit submissions.

Manages the internal government billing audit database including data entry, audit management, trouble shooting, and serves as the system application expert.

Proactively research current and upcoming government billing audit areas to keep impacted PeaceHealth caregivers and leaders informed while looking for educational opportunities.

Responds to alleged violations of rules, regulations, policies, and procedures related to findings from government billing audits through the initiation of compliance investigations and remediations as applicable.

Develops reports, presentations, and data analytics related to government billing audits as directed including routine and ad hoc requests.

Recommends compliance controls (such as education/training, policies, procedures) to operational owners related to compliance issues or weak processes discovered during the government billing audit process.

Participates in the Healthcare Compliance department Annual Risk Assessment process.

Cross-trains with other department members on supporting tasks and provides training on government billing audit program to ensure program continuity during absences.

Performs other duties as assigned.

What you will bring:

Bachelor's Degree in Healthcare Administration or equivalent discipline.

Minimum of 7 years relevant compliance, audit, and/or clinical operations experience.

Experience navigating medical records within an EMR application.

Experience working with government contracted auditors.

EPIC experience preferred.

Certified Professional Coder, Certified in Healthcare Compliance or Certified Coding Specialist required within 18 months.

Additional Skills:

Extensive knowledge of Medicare and Medicaid government billing auditor compliance audit methodologies, principles, and techniques including documentation, coding rules, requirements, and guidelines.

Ability to research, interpret, and apply documentation and coding rules and regulations.

Strong skills and experience developing and performing core compliance program functions, including investigations, case management, pro-active billing auditing/monitoring, remediations (corrective actions), risk assessments, policies, education, root cause analysis, and controls assessments.

Outstanding verbal and written communications, interpersonal and leadership skills.

Demonstrated ability to effectively communicate and interact with all levels of leadership.

Ability to successfully navigate difficult conversations and influence staff at all levels.

Strong presentation, data analysis, and report creation skills including the ability to report out to all levels of PH leadership.

Exemplary moral compass including unwavering commitment to ethical behavior and confidentiality.

Clear, intentional, and strategic communicator including helping caregivers find clarity in compliance-related matters.

Proven ability to thrive in a fast-paced changing environment and successfully manage multiple investigations and projects simultaneously.

Proactiveness and curiosity with the ability to work independently.

Excellent analytical and problem-solving skills.

Advanced skills in all MS Office applications (Word, Excel, Outlook, PowerPoint).

Ability to travel to other PeaceHealth facilities and locations.

Working Conditions

Consistently operates computer and other office equipment.

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.

Sedentary work.

Predominantly operates in an office environment.

Ability to communicate and exchange accurate information.

The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

The salary range for this job opening at PeaceHealth is $40.22 – $60.34. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility .

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

PeaceHealth requires a completed Primary Vaccine Series (e.g., 2 dose monovalent Pfizer, Moderna or Novavax series or 1 dose JJ vaccine series) or be Up to Date (receiving the most recent Pfizer/Moderna bivalent vaccine/booster) for COVID-19 vaccination prior to their start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due to medical/religious reasons. For caregivers that will be working in Oregon there is a personal vaccine exemption form that may be requested.

REQNUMBER: 88462