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Compliance Senior Manager
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- The Compliance Senior Manager also has experience in general healthcare compliance matters, particularly as they relate to federal Medicare, Medicaid, Fraud, Waste and Abuse laws, including but not limited to OIG, Stark, and Anti-Kickback Statutes and all other applicable regulations, including the development of general compliance policies and procedures, training, and auditing.
- Supports the billing department with: CPT coding and billing reimbursement advice and assistance, government and commercial payer inquiries, internal audits, prepayment reviews and recoupments, management of 3rd party billing and coding audits, monitoring and analyzing trends in claim submissions to identify payment inconsistencies or errors and the corresponding corrective actions, and identification of areas where training and education are needed.
- Conducts regulatory research to maintain expertise and support compliance training and education related to Federal, State and local laws and regulations, enforcement initiatives, third party coding, billing and claims submission, financial arrangements with physicians, conflicts of interest and internal policies and procedures.
- 5+ years’ experience with billing compliance management in a healthcare setting, preferably a genetic testing laboratory.
- Expertise with coding for genetic testing services using Next Generation Sequencing (NGS).
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