Manager, Physician Practices and Ambulatory Care Compliance Jobs in Iselin at Hackensack Meridian Health

Overview

Our team members are the heart of what makes us better.

At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.

Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.

The Compliance Manager for Physician Practices and Ambulatory Care is responsible for the development, implementation, and oversight of the compliance program for the organization's physician practices and affiliated ambulatory care services. This position ensures the integrity of the practice's regulatory environment by actively monitoring changes in healthcare laws and regulations. The manager will proactively research, investigate, and respond to issues related to documentation, coding, billing, and licensure. This role is critical in assuring compliance with all payer and regulatory requirements, including but not limited to those of Medicare, Medicaid, and applicable state laws.

This is a Hybrid Position overseeing 4 people

Responsibilities

A day in the life of a Compliance Manager for Physician Practices and Ambulatory Care at Hackensack Meridian Health includes:

• Performs and oversees retrospective and concurrent audits and performance improvement reviews to ensure compliance with regulatory and payer requirements.
• In partnership with the Deputy Chief Compliance Officer, manages staff auditors.
• Reviews physician and advanced practice provider documentation in the medical record for appropriateness and to ensure that billing is reflective of the services provided.
• Reviews medical records to assess appropriate ICD-10 and CPT-4 assignment for Medicare, Medicaid, and commercial payers for reimbursement purposes.
• Develops, implements, and maintains an effective compliance program, including policies, procedures, and a compliance manual for physician practices and ambulatory care.
• Maintains current knowledge of payer and regulatory requirements, including federal and state laws such as the Stark Law and Anti-Kickback Statute.
• Develops content and conducts ongoing compliance training and education for physicians, management, and staff on relevant laws, regulations, and identified risk areas.
• Facilitates the timely submission of accurate claims through daily interaction with practice leadership, physicians, coders, and the Physician Billing Department.
• Monitors all aspects of the revenue cycle to ensure compliant reimbursement and provides reports to leadership as needed.
• Manages and conducts investigations into compliance-related concerns, ensuring timely and thorough resolution.
• Serves as an active participant in workflow development within the practice and the Electronic Health Record to ensure compliant documentation and billing.
• Acts as a liaison to the Physician Billing Department and any external coding or billing services, maintaining open lines of communication.
• Prepares and presents regular reports to the Deputy Chief Compliance Officer and Compliance Committee on program status, audit findings, and investigative matters.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Qualifications

Education, Knowledge, Skills and Abilities Required:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• Minimum of 5-7 years of experience in healthcare compliance, with significant experience in auditing, coding, and physician practice/ambulatory care settings.
• In-depth knowledge of federal and state healthcare regulations, including Stark Law, Anti-Kickback Statute, and HIPAA.
• Proficiency with ICD-10 and CPT-4 coding methodologies, physician documentation, and reimbursement principles.
• Demonstrated experience in developing and implementing compliance programs, conducting audits, and leading investigations.
• Proficiency in the use of electronic health records (EHRs), preferably Epic Ambulatory.
• Strong analytical, problem-solving, and project management skills.
• Excellent interpersonal, presentation, and written communication skills.
• High degree of professionalism, integrity, and ability to work collaboratively with physicians, staff, and leadership.
• Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Education, Knowledge, Skills and Abilities Preferred:

• Familiarity with The Joint Commission (TJC), state Department of Health, and CMS regulations.
• Proficiency in Epic Ambulatory.

Licenses and Certifications Preferred:

• Certification in Healthcare Compliance (CHC).
• A coding credential (e.g., CPC, CCS).

If you feel that the above description speaks directly to your strengths and capabilities, then please apply today!   

Compensation
Minimum rate of $131,144.00 Annually

HMH is committed to pay equity and transparency for our team members. The posted rate of pay in this job posting is a reasonable good faith estimate of the minimum base pay for this role at the time of posting in accordance with the New Jersey Pay Transparency Act and does not reflect the full value of our market-competitive total rewards package.

The starting rate of pay is provided for informational purposes only and is not a guarantee of a specific offer. Posted hourly rates may be stated as an annual salary in the offer and posted annual salaries may be stated as an hourly rate in the offer, depending on the level and nature of the job duties and credentials of the candidate. The base compensation determined at the time of the offer may be different than the posted rate of pay based on a number of non-discriminatory factors, including but not limited to:

• Labor Market Data: Compensation is benchmarked against market data to ensure competitiveness.
• Experience: Years of relevant work experience.
• Education and Certifications: Level of education attained, including specialized certifications, credentials, completed apprenticeship programs or advanced training.
• Skills: Demonstrated proficiency in relevant skills and competencies.
• Geographic Location: Cost of living and market rates for the specific location.
• Internal Equity: Compensation is determined in a manner consistent with compensation ranges for similar roles within the organization.
• Budget and Grant Funding: Departmental budgets and any grant funding associated with the job position may impact the pay that can be offered.

Some jobs may also be eligible for performance-based incentives, bonuses, or commissions not reflected in the starting rate. Certain positions may also be eligible for shift differentials for work performed on evening, night, or weekend shifts.

In addition to our compensation for full-time and part-time (20+ hours/week) job positions, HMH offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits.

HACKENSACK MERIDIAN HEALTH (HMH) IS AN EQUAL OPPORTUNITY EMPLOYER

All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, breastfeeding, genetic information, refusal to submit to a genetic test or make available to an employer the results of a genetic test, atypical hereditary cellular or blood trait, national origin, nationality, ancestry, disability, marital status, liability for military service, or status as a protected veteran.

Our Network

Hackensack Meridian Health (HMH) is a Mandatory Influenza Vaccination Facility

As a courtesy to assist you in your job search, we would like to send your resume to other areas of our Hackensack Meridian Health network who may have current openings that fit your skills and experience.