Director of Compliance - Clinical/Reimbursement

Community
Charlestown/Corporate - Catonsville, MD
Job Category
Chief Compliance Office
Schedule

Full-time

Job ID
20112747
Posting Date

Erickson Living is hiring for a Director of Compliance – Clinical and Reimbursement who collaborates with the Chief Compliance Officer to coordinate and oversee healthcare billing and OIG Workplan-related compliance activities of Erickson and its managed communities. The director will work with the compliance team to conduct compliance reviews according to the organization’s Compliance Plan. This individual will lead audits and other reviews in response to items on the OIG Workplan and other special guidance, co-chair the Erickson Policy Oversight Committee and oversee administration of the Compliance database. This individual will, with the Chief Compliance Officer, lead risk assessment and planning related to compliance and, with the Director of Compliance - Education and Policy will provide education and guidance to staff related compliance activities    

 

How you will make an impact:

  • Oversees compliance risk assessments and on-going compliance monitoring activities in coordination with the compliance and operational assessment functions.
  • Oversees community, ELM and third-party compliance reviews.
  • Creates and manages audit protocol for health care business line subject to government regulations including but not limited to Medicare. 
  • Coordinates and performs, with the compliance team and professionals from Health Operations, compliance audits performed in the Erickson-managed communities and corporate offices.
  • Leads organizations educational training efforts related to clinical compliance activities.
  • Researches and analyzes OASIS, PEPPER  and MDS data in conjunction with medical charts to assure compliance with Medicare, Medicaid and other third party payers, as well as to confirm appropriate reimbursement. 
  • Recommends best practices for compliance with Medicare and Medicaid regulations; as well as to improve procedures, revenue and strengthen controls.
  • Coordinates distribution of compliance-related findings related to compliance reviews and other opportunities for improvement to management and staff, and provides educational training related to claims. 
  • Leads other healthcare compliance reviews as indicated by guidance, regulations and events, including OIG Workplan guidance. 
  • Co-chairs Erickson’s Policy Oversight Committee and assures that policies are appropriate vetted.
  • Represents the Compliance Department on the ELM Pharmacy and Therapeutics Committee quarterly and as needed, and other organization-wide groups as assigned.  
  • Coordinates third party review Medicare Provider claims and assesses results of claims review.
  • Works at the direction of the Chief Compliance Officer to investigate compliance complaints, as well as compliance and healthcare-related complaints arising under Erickson’s Values Line. 

What you will need:

  • Licensed healthcare profession required.
  • Minimum of five years of management experience with progressively more responsible positions is required.
  • Chart review and MDS and/or OASIS experience required. 
  • Must be proficient in Medicare and Medicaid regulations.