Supervisor of Compliance - CPC or CCS Certified

Supervisor Of Compliance - Cpc Or Ccs Certified

The Supervisor Of Compliance will provide support, education and training to physicians and other providers on medical record documentation, risk adjustment, and compliance activities and implementation. They will make consultative presentations to various organizational levels; assist with regulatory compliance; manage a small team; and collaborate with physicians, advanced practice providers (APPs), and administrative leaders. The role also involves managing projects or compliance components of larger cross-functional projects, developing, and coordinating plans, and working with stakeholders.

This will include the supervision and coordination of daily activities of the designated work team; development and presentation of training materials and/or reports related to medical record documentation and risk adjustment; and implementation of company compliance activities. The position requires in-depth knowledge of medical coding and risk adjustment, especially in the ambulatory space.

This position is primarily responsible for leading company compliance activities in collaboration with internal and external stakeholders and providing insight and recommendations for the design, development, and execution of strategic compliance initiatives. Responsibilities include developing compliance reports, conducting compliance investigations, coordinating implementation of compliance efforts, and assisting with regulatory compliance through monitoring regulatory changes. This position also supports the management of projects or compliance components of larger cross-functional projects including assisting in development and coordination of plans and coordinating with stakeholders.

Essential Responsibilities:

• Pursues professional growth by soliciting and acting on performance feedback; building collaborative relationships; training and developing talent for growth opportunities; delegating tasks and decisions; fostering open dialogue amongst team members; supporting execution of performance management guidelines and expectations; ensuring team collaboration; providing team members feedback; and mentoring and coaching to drive performance improvement.
• Supervises and coordinates daily activities of designated work team or unit by monitoring the execution and completion of tactical action items and work assignments; ensuring all policies and procedures are followed; delegating tasks to meet short term objectives; aligning team efforts and measuring progress in achieving results; identifying and recommending improvement opportunities; and removing obstacles that impact performance.
• Leads company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Minimum Qualifications:

• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field AND Minimum six (6) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Additional Requirements:

Preferred Qualifications:

• Four (4) years experience in health plan compliance.
• Four (4) years medical coding experience and Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or Certified Coding Specialist (CCS) medical record coding certifications.
• Two (2) years project management experience.
• Three (3) years health care experience.
• Three (3) years experience working cross-functionally across departments, functions, or business lines.
• Master's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.