Manager, Billing Compliance - Hematology & Medical Oncology

Manager of Billing Compliance

The mission of The Tisch Cancer Institute is to accelerate the prevention and treatment of cancer, improving the lives of cancer patients and their families in our communities. As a leading National Cancer Institute-Designated Cancer Center, we leverage a multidisciplinary approach to research and treatmentwith the goal of advancing clinical breakthroughs that transform patient care.

The Manager of Billing Compliance has a broad understanding of billing compliance as it relates to Federal and State regulations concerning clinical documentation requirements, billing and reimbursement. Responsibilities include routine clinical documentation monitoring, reviews, education and training in Part A & Part B billing and reimbursement compliance. Ensures clinical documentation elements are satisfied for Federal and State regulations via focused and / or general monitoring, education and training related to the institutions Compliance Program. Responsible for assigned clinical departments in the Medical Center.

Responsibilities

Performs monitoring activities on all assigned areas based on risk profiles of the department. Notifies department Chair / Divisional Chief / Liaison Officer / Administrator of scheduled monitoring initiatives. Meets with Administrator or other appropriate staff to discuss specific processes and other information related to billing that is unique to the specialty.

Develops all billing compliance program content for training purposes and ensures successful execution.

Analyzes Utilization Billing Report of paid services for each service / physician and determines sample selection for review. Collaborates with Administrator or other appropriate personnel regarding refund process to third party payor(s) as appropriate. Maintains file of all monitoring data for each assigned area.

Performs chart abstraction either retrospectively or concurrently. Meets with individual physicians to discuss analysis report and findings.

Implements and administers web-based training system for organization-wide compliance training.

Conducts regulatory research to support compliance training and education related to Federal, State and local laws and regulations, third party coding, billing and claims submission, financial arrangements with physicians, conflicts of interest and internal policies and procedures.

Promotes compliance initiatives and awareness throughout the institution.

Assists the VP and Compliance Department leadership team in identifying areas where training and education are needed, and develops appropriate materials and information to support the Compliance Program.

Creates and maintains project schedules by developing project plans and specifications, estimating timelines, establishing deadlines, monitoring milestone completion and tracking all phases of the project lifecycle.

Other duties as assigned by leadership.

Qualifications

Bachelors degree preferred.

5 years relevant experience, preferably with 3 years in a leadership capacity; knowledge of CPT / ICD-10 and current HCFA / Medicare regulations governing billing compliance.

Current CPC / CPT certification.

Required Skills

MS Excel

MS PowerPoint

MS Word

Microsoft Access

Outlook