Compliance Manager Professional Pediatrics and Radiology

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Compliance Manager, Professional (Pediatrics and Radiology)
Duties: Support Hospital Compliance Program by: managing the institution-wide conflicts of interest program; assisting in or leading compliance investigations as appropriate; performing assigned projects to support the annual compliance plan and operation of an effective compliance program; providing education and training to Hospital personnel on compliance, conflict of interest, and privacy matters; and supporting the operations of the compliance program. Responsible for advising senior management of the Departments of Pediatrics and Radiology about compliance matters. Provide documentation and compliance educational sessions to physicians and other staff. Also oversee the performance of physician chart reviews and the resolution of code change requests. Work closely with the Abstraction Manager and the Senior Director, in collaboration with the Institution’s Vice President for Compliance, to ensure that communication regarding compliance issues is timely, accurate and complete. Advise Senior Management of the Department of Pediatrics about compliance matters. Investigate and advise senior management about regulatory changes in compliance requirements. Thoroughly research requirements via CMS websites and appropriate coding and compliance experts. Develop recommendations to meet new regulations, including procedures for communication and educational requirements. Analyze coding issues/questions. Develop and implement a system to document, communicate and file responses to all coding and compliance questions. Provide compliance and documentation education sessions to physicians and other staff, either as a group or on an individual basis, as needed. Provide accurate and timely information on regulatory requirements. Provide coding expertise for compliance issues. Maintain attendance lists for all presentations, as well as logs of issues identified for future research and response. Develop educational materials related to documentation and compliance. Collect assessments of educational sessions to use in improving future presentations. Provide compliance expertise in meetings with billing personnel, and administrative and clinical leaders of the Department. Participate in monthly meetings of billing and other administrative staff to review and address compliance issues. On a monthly basis, review bundling rejections to advise appropriate follow-up strategies. Participate in quarterly meetings of the Administrative Directors to provide advice and leadership in compliance matters. Participate as an active member of the Department and Institution’s Professional Services Compliance Committee. Contribute to the agendas and present relevant issues for discussion. Collaborate with the Abstraction Manager and PARC Revenue Cycle staff to enhance communication among abstraction, compliance, reimbursement and billing staff and to ensure cooperation where hospital and practice coding are linked. Work with Abstraction to identify and address general and service-specific questions appropriately and in a timely fashion. Provide training and educational materials for the abstraction team. Oversee the provision of coding advice to outpatient practice staff. Supervise the creation of coding reference sheets. Coordinate review efforts with Hospital staff.

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