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Senior Compliance Manager, Healthcare

Company: Emonics, LLC
Location: Remote
Posted on: November 25, 2022

Job Description:


  • Bachelor's degree required; advanced degree in Business Administration, Public Health, Healthcare Administration, or Information Management preferred
  • strongly prefer credential with the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
  • Required Certified Risk Adjustment Coder (CRC) certification.
  • Preferred 5+ years of healthcare experience (e.g., health plan and/or ACO managing risk adjustment for Medicare Advantage products), including tenure with a reputable management consulting firm with healthcare experience (e.g., forensics services, investigations, claims and disputes, compliance);
  • Experience required working in healthcare industry dealing with federal healthcare program laws including the False Claims Act;
  • Experience required with development, implementation, and maintenance of Medicare Fee-for-service and Medicare Part C risk adjustment compliance programs including, but not limited to, revenue cycle management, medical documentation and risk adjustment governance, coding guidelines, related policies, coder inquiries, medical documentation, and monitoring and auditing of medical documentation and coding;
  • Experience designing and implementing data analytics related to revenue cycle and risk adjustment;
  • Experience with medical coding including ICD-10 and HCC risk adjustment coding;
  • Self-motivated, team player with proven ability to identify issues and manage priorities in a fast paced environment while striving for practical business solutions;
  • Hands on, efficient and proven ability to "Get Stuff Done with a bias for action and a strong sense of ownership.
  • Other preferred skills and experiences include:

    • Strong organizational and project management skills with demonstrated attention to detail;
    • Experience designing, maintaining, or working with electronic health record systems including Cerner platform;
    • Experience managing risk adjustment vendors or other related 3rd parties;
    • Experience managing RAD-V and RAC audits;
    • Experience conducting internal medical documentation and coding audits;
    • Experience designing provider outreach and education programs related to medical documentation and coding;
    • Experience with actuarial, finance, and/or operational activities of a health plan;
    • Experience in positively and successfully managing relationships with a high energy and diverse group of leaders across organizational lines;
    • Solid technology skills including Excel and PowerPoint including experience with creating data analytics;
    • A thoughtful, articulate and effective communicator who can distill and articulate the important aspects of any issue to a wide audience of participants;
    • Ability to quickly establish credibility and expert at quickly creating trusted advisor relationships with senior leadership to navigate complex matters;
    • Superior written and verbal communication skills (including presentations) and the ability to drive execution in a team environment; and
    • Demonstrated management level presentation experience.

Keywords: Emonics, LLC, Eugene , Senior Compliance Manager, Healthcare, Healthcare , Remote, Oregon

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