Vacancy caducado!
Compliance Manager-RN/Certified Coder (PS34142)Location: United StatesNewRequisition #: PS34142Compliance Manager-RN/Certified Coder (PS34142)Must be able to sit onsite in an Anthem office or work remote.There are two Compliance Manager openings. One opening is for an RN and the other opening is for a professional coder. The experience will be focused on risk adjustment provider investigations. Responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.Primary duties for this managing level position, with moderate to advanced complexity and broad/enterprise scale may include, but are not limited to:
Develop and improve risk adjustment investigation process and tools.
Collaborate with clinical, data, and medical coding partners to assess provider and associate behavior for fraud, waste and abuse.
Conduct medical record reviews and risk assessments.
Develop materials to support investigative interviews related to investigations.
Conduct complex investigations and document findings.
Develop corrective action plans and monitor for timely remediation.
Maintain knowledge of laws, regulations, and company strategies to assess impact, and consult with clients as subject matter expert.
Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
Assist in developing reporting and present findings to management.
Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
Maintain knowledge of laws, regulations, and company strategies to assess impact, and consult with clients as subject matter expert.
Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
Qualifications:
Requires a BA/BS; MS/MBA/JD or professional designation preferred; at least 6+ years of health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.
Ability to travel may be required.
Must be able to sit onsite in an Anthem office or work remotely.
Must have a coding certification or an RN certification.
Risk adjustment, HPC coding expertise is an assetAnEqualOpportunityEmployer/Disability/Veteran
Vacancy caducado!