Job Abstract

Reports to the Director of Coding/Compliance/HIM and is responsible for leadership, guidance, and supervision of the staff assigned to MSO services. Responsible for leading the auditing and compliance functions, ensuring that regulatory requirements and hospital policies are maintained. The person in this role provides guidance, advice, and leadership to resolve complex and critical issues, ensuring that the MSO services maintain the highest level of compliance while still meeting the needs of patients, physicians, and staff. Develops training and education providers to achieve compliance with all documentation and coding guidelines.

The Manager demonstrates strong leadership skills, a sense of urgency, and is proactive in their approach. The person will demonstrate effective decision making, judgment, communication, and modeling of the Atlantic Health System (AHS) mission and the Trusted Network of Caring.

• Provide coding and billing assistance to MSO services to increase understanding of compliance regulations based on findings from billing and patient records.
• Oversee auditing processes ensuring the performance of internal audits for MSO providers/practices. Evaluation all CPT/procedures codes utilized for accuracy and consistency with CMS guidelines. Provision of training and education to address coding/compliance issues.
• Provide Auditing/Coding/Compliance assistance to MSO services to increase understanding of compliance regulations; based on workflow assessment results. Initiate provider/practice training opportunities to review and educate on results
• Manage and educate new staff on EMR systems, auditing processes, policies and procedures.
• Remain current on federal and state regulations changes.
• Provide education to physicians and staff regarding the compliant use of technology; as well as, participate in the implementation and maintenance of technical systems (EMR, Billing System, devices, etc). Continually serve as a resource for education, training, guidance, and build of clinical applications.
• Update MSO services of any new coding or compliance rules, CPT changes, HCPCS changes, ICD-10 changes.
• Manage, educate, and orient new staff regarding policies & procedures, audit rules and systems used by the department.
• Report compliance data to external agencies such as the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS)
• Work with third-party payers and agencies to comply with audits