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 ManagesalloperationswithintheCompliance,InternalControlsandSecurityDepartmentinconjunctionwithdirectionfromleadership.Providesoversight,direction,andsupportofstaffandallcompliancerelatedactivities,includingInternalControlsandSecurityTesting.Responsiblefordevelopment,maintenanceandimplementationofRevenueManagement’sComplianceProgram.InterfaceswithallrelevantdepartmentstocoordinateandmonitorconsistencywithComplianceProgram andwithapplicableregulatoryrequirementsandreportstheseresultstotheappropriateleaderandadministrativedepartments.Expectedtobethesubjectmatter expertregardingissues inthefieldofcoding andbillingcompliance.Leadseffortswithin theorganizationtopromotecompliancethrougheducation,training,audits,andother meansasappropriate.Coordinatesexternal audits,includingappropriateresponseandthepreparationofoperationalimprovementplans.Disseminatesinformationtokeystakeholdersonatimely basis.Reportscomplianceactivitytovarious internalcompliancecommitteesasneeded.ResponsibleasMedicare compliancesubjectmatterexpertforunderstandingallregulatoryrequirementsapplicabletotheMedicarelineofbusiness,andfortracking changestosuchrequirements.Withrespecttogovernmentalpayers, coordinatesthedevelopmentofandoversees theimplementationandmaintenanceofaninvestigationandremediationprocess toensureprompt responsetoaninvestigationofanyaction inconsistentwithapplicable regulatoryrequirements.Reportstheresultsofinternalcontroltesting toleadershipandmakesrecommendationsoncorrectiveactionplans.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.
Education Bachelor's Degree- (Required), Master's Degree- (Preferred) Experience Minimum of 5 years-Managerial/Supervisory (Required), Minimum of 7 years-Related work experience (Required) Skills Office Administration About GeisingerFounded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.
Our Commitment to Diversity, Equity and InclusionGeisinger values who you are, where you are from, and where you are going. We seek out people of various backgrounds and cultures with unique abilities, non-traditional career paths and ambitious aspirations. 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. Read more about Our Commitment to Inclusive Recruiting.
Our Vision & ValuesEverything we do is about making better health easier 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.
Our BenefitsWe offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.