Manager Professional Fee Billing Compliance

About the role

The Manager Professional Fee Billing Compliance reports directly to the Director of Professional Fee services. The Manager manages the scheduling and performance of routine and risk-based chart reviews for billing providers within Penn Medicine Practice Plans. The position is responsible for the day-to-day management of Compliance Analysts in performing professional fee audits and new provider education. The manager oversees the professional fee chart reviews to include: planning, sampling, prioritization of audits, quality assurance and reports. Conducts post-audit close meetings with department/division leadership to provide audit feedback and next steps. The Manager actively participates in individual meetings with providers to discuss documentation improvement to limit external audit risk.

Location: 150 Monument Road, Bala Cynwyd, PA (hybrid)

Responsibilities

• Leads the systematic reviews of the professional fee billing for the faculty members of Penn Medicine to ensure thorough appropriate sampling that medical documentation supports all billed services
  • Daily supervision of Compliance Analysts to include but not limited to:
    • Serving as a coding, documentation, and policy and procedure resource
    • Providing support with issue resolution
  • Participates in research related to inquiries made to the Office of Billing Compliance to include but not limited to:
    • Researching relevant regulations and communicating the need for policies, procedures and education
    • Providing billing, coding and documentation guidelines in accordance with regulatory and correct coding concepts
  • Performs medical record documentation and coding/billing audits to identify patterns and trends during these audits
  • Coordinates with Office Manager in scheduling and workload distribution for Compliance Analysts
  • Performs data analysis and coordinates with Office Manager in sample selection incorporating data mining techniques and benchmark comparison focusing on identification of high risk areas; ability to manipulate Software to create necessary reports
  • Ensures progressive audits are performed for providers with unfavorable audit findings
  • Conducts and manages quality assurance to ensure accurate and equitable citation for audit review findings
  • Prepares and leads post audit results meetings with Chairs/Division Chiefs/COOs/Administrators
  • Monitors Compliance Analysts’ productivity
  • Organizes and actively participates in post audit close meetings and requested one-on-one physician/provider meetings
  • Identifies potential areas of risk using data
• Direct supervision of all professional fee Compliance Analysts and Senior Compliance Analysts
  • Recruits and retains talented results oriented team
  • Develops and maintains effective succession and contingency plans to ensure continued operations
  • Monitors daily productivity and accuracy
  • Conducts performance annual evaluations (in conjunction with Director of Professional Fee)
  • Assists with addressing challenges and skill deficits
  • Provides support and guidance
  • Establishes and ensures effective and ongoing communication vehicles such as regular one-on-ones, professional fee staff meetings and chart seminars
• Provides assistance and support when necessary, to Compliance and Quality Review Analyst to include but not limited to:
  • Ensuring accuracy of findings and preparing summary report of findings within a timely manner
  • Ensuring that medical records support all billed services by the medical staff in accordance with correct coding guidelines
• Co-presents at annual education sessions on an as needed basis to include but not limited to:
  • Provide any relevant internal review findings to the Physician Educator for possible inclusion in presentations
• Provides support and needed research to Director of Professional Fees in Due Diligence projects to include but not limited to:
  • Assessment of Data regarding the entity in question
  • Providing insights and recommendations on pertinent data
  • Procuring any information needed to obtain a robust understanding of the entity in question
• Participates in OBC’s design, implementation and completion of a risk-based annual compliance work plan incorporating governmental and other agency regulations and industry alerts, compliance program requirements, and policies and procedures
• Pursues ongoing training and development to ensure the department role in providing additional expertise in fulfilling the elements of an effective compliance program include but not limited to:
  • Keeping abreast of OIG areas of interest via website or listserve
  • Monitoring Novitas areas of interest via website or listserve
  • Maintaining open communications with Manager of Government Audits and Appeals
• Maintains professional skills and knowledge through attendance at relevant educational programs, participation in professional organizations and applicable webinars; and by reviewing current literature to include but not limited to:
  • Participating and presenting at the department’s Quarterly Coding and Billing Compliance Seminar
  • Attending local AAPC symposiums as budget would allow
• Maintains confidentiality with respect to medical records and corporate documents (HIPAA, JCAHO, etc.)
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department