Reporting to the System Director of Compliance, the Senior Manager of Revenue Compliance develops and deploys strategies to mitigate organizational risk related to the submission of claims for reimbursement by state, federal and private payers. The Senior Manager of Revenue Compliance partners closely with key stakeholders such as Revenue Cycle, Clinical Documentation Improvement, Health Information Management, Information Technology, and various clinical and non-clinical departments to provide oversight and independent assessment involving documentation, coding and billing practices and related processes across the System.

1. Assists with the development and oversight of System-wide revenue compliance audit initiatives, per the CAS Work Plan, developing strong working relationships with system management, employees and key stakeholders. When necessary, facilitates the process for reporting and refunding identified overpayments to the appropriate payers.
2. Conducts revenue compliance audits in accordance with the CAS Work Plan in collaboration with key stakeholders including providers, hospital management, Clinical Documentation Improvement and billing and coding. Drafting reports of audit activity, obtaining management response to written recommendations and tracking for completion of agreed upon corrective action plans.
3. Supports hiring, orientation, training and management of CAS revenue compliance employees. Oversees work of third party consultants and vendors when necessary. Engages all CAS staff through routine communication to promote a productive and respectful work environment.
4. Assists CAS leadership with revenue compliance investigations or Office of Inspector General, Attorney General’s Office, or other legal entities, and organization officers in revenue compliance reviews or investigations.
5. Prepares reports summarizing revenue compliance and audit activities as needed, to share with leadership and the Audit and Compliance Committee of the Board.
6. Maintains current knowledge of applicable federal and state laws and other regulations and accreditation standards, and monitor advances in revenue compliance and audit standards and changes in regulations to ensure organizational adaptation and compliance. Participate in outside healthcare compliance organizations to stay abreast of developments and best practices within the industry.
7. Assists with the development of CAS department policies and procedures.
8. Participates in revenue compliance-related training efforts, investigations, management of governmental audits and policy and procedure development.
9. Assists with annual and on-going risk assessment activity designed to identify and risk rank potential areas of department review or auditing.
10. Serves as a resource to the system regarding revenue compliance matters and inquiries
11. Stays current on documentation, coding and billing regulations via professional organizations and via personal research and education on payer rules, requirements and regulatory guidelines.
12. Performs other duties as required or assigned.

• Working knowledge of applicable Federal and State of New Hampshire documentation, billing and coding regulations.



• Preferred Qualifications include:



• Certification in healthcare compliance



• CPC, RHIA, CCS-P, CPMA, CMAS Certifications



• Effective organizational skills and a strong attention to detail.



• Effective professional written and oral communications skills.



• Strong interpersonal skills



• Ability to assess and resolve problems that require research and review of policy, procedures, and regulations.



• Competency in Microsoft Office programs (Word, Excel, and PowerPoint).



• Minimum of three (3) years of supervisory experience.



• Minimum of five (5) years of experience in billing, coding and documentation or revenue cycle auditing.



• Professional training and experience in healthcare billing, coding and documentation.

• None