As a UW employee, you have a unique opportunity to change lives on our campuses, in our state and around the world. UW employees offer their boundless energy, creative problem solving skills and dedication to build stronger minds and a healthier world. UW faculty and staff also enjoy outstanding benefits, professional growth opportunities and unique resources in an environment noted for diversity, intellectual excitement, artistic pursuits and natural beauty. All of which has allowed the UW to be nationally recognized as a "Great College to Work For" for five consecutive years.UW Medicine Compliance has an outstanding opportunity for a Clinical Billing Integrity Manager - Audits and External Reviews.The Clinical Billing Integrity Manager - Audits and External Reviews is a leader who reports directly to the Director. They are responsible for overseeing and coordinating systems and initiatives required to establish an effective facility billing compliance program for UW Medicine (UWM). At the direction of the Director, the Clinical Billing Integrity Manager - Audits and External Reviews develops and implements UWM compliance program strategic goals, oversees applicable elements of an effective compliance program as outlined by the Federal Sentencing Guidelines, directs resources to accomplish the goals and mission of the unit, and ensures efficient and effective operations. The Clinical Billing Integrity Manager - Audits and External Reviews also works cooperatively with other UWM compliance leaders, the CCO/AVPMA, UW Health Sciences risk managers, and entity leaders to identify and resolve shared issues and concerns. Internally, the Clinical Billing Integrity Manager - Audits and External Reviews works closely with the Director to develop unit-wide expectations for employees, maintain and monitor staffing levels, identify and document critical knowledge-skills-attributes for employees, and establish strategic plans for recruiting and retaining quality staff. The Clinical Billing Integrity Manager - Audits and External Reviews ensures that the performance evaluation and reward system achieve unit goals for excellence and employee motivation. The Clinical Billing Integrity Manager - Audits and External Reviews is a full partner with the Director in developing the short-term and long-range strategic goals for both unit-based and system-wide compliance operations, initiatives, and projects, and serves as project director for major initiatives. As a confidential assistant to the AVPMA/CCO and Director, the Clinical Billing Integrity Manager - Audits and External Reviews uses discretion to advance issues on behalf of the AVPMA/CCO and Director, and operates independently using judgment and discretion to handle sensitive operational, implementation, and organizational concerns.RESPONSIBILITIESOversee daily activities associated with the risk areas and program functions under the auspices of the Director, advise the Director about program operations and risk assessment/mitigation strategies, monitor regulatory developments and recommend program modifications.Effectively supervise and allocate resources and talent in order to meet program objective(s).Manage the development and implementation of policies and procedures for UWM Compliance, working closely with the Director, enterprise-wide content experts, legal counsel(s), and administrative staff.Demonstrate team leadership by effectively managing, both directly and through influence, and guiding teams and group efforts; provide an appropriate level of feedback concerning progress in order to execute unit goals.Develop proactive and reactive education and training content sufficient to address and mitigate organizational compliance-related risk.Ensure effective monitoring, auditing and risk assessment activities; conduct riskParticipate and or lead enterprise-wide risk analysis as needed and report findings as well as mitigation plans to the Director.Effectively engage in the development and implementation of the annual Compliance work plan; coordinating with the Director, AVPMA/ CCO, other directors and enterprise-wide compliance officials and content experts.Serve as a resource for current documentation, coding, billing and related regulatory guidelines.Maintain and report regularly on program activities, work plans, project plans, and investigatory mitigation plans.Participate in or convene institutional committees and/or workgroups as assigned by the Director.Serve as in-house expert on matters of regulatory compliance and maintain awareness of laws, regulations and status of current enforcement initiatives.In conjunction with the AVPMA/CO, unit directors, managers and other staff, develop and implement effective policies and procedures that address regulatory requirements, including hotline, triage/case management, investigations and resolutions, inquiries, complaints, and consultation requests.Oversee creation and maintenance of written documentation for the Compliance Program (e.g., committee minutes, charters, process improvement projects, corrective action plans) as required by applicable regulations; retain records in accordance with the UW Records Retention Schedule.Work closely with other university officials when there are mutual concerns, system-wide policy needs, and urgent or emergent issues.The position operates independently using judgment and discretion to handle sensitive compliance program and political issues.Lead ResponsibilitiesIncumbent sets clear standards of service and high-quality performance, regularly monitors performance against established standards, provides ongoing feedback to team members and supervisees and offers appropriate guidance. Individual in this position holds employees accountable for achieving performance standards and rewards and recognizes exemplary performance while appropriately addressing poor performance.Supervisory ResponsibilitiesThis position supervises six clinical billing compliance analysts.REQUIREMENTSBachelor's degree in a Health Sciences discipline, Business Administration, or related field .Seven or more years of healthcare administration, management, or compliance leadership experience in a complex organization and three or more years' experience managing staff.Current coding certification: CPC, COC, CCS, CCS-P, RHIT, RHIA.Ability to lead, inspire and develop a team of high performing individuals.Extensive knowledge of ICD-10-PCS, ICD-10-CM, CPT and HCPCS coding principles and guidelines.Comprehensive knowledge of federal and state regulations related to documentation, coding and billing.Strong financial management, strategic planning, project management, business and operations management experience.Excellent cross-group collaboration skills, demonstrated executive maturity and ability to impact and influence people at all levels in the organization.Must demonstrate strategic thinking, business insight and creativity in resolving problems.Coding, documentation and reimbursement content area expertise in one or more of the following: utilization management, medical necessity, inpatient coding, or outpatient coding.Proficiency with MS Word and Excel.Excellent oral and written communication skills.Self-motivated, detail-oriented and highly organized skill set.DESIRED QUALIFICATIONSExperience in an academic medical center.Certified in Healthcare Compliance (e.g. HCCA/HCCB CHC certificate).Proficiency with electronic medical records systems, databases, and related automated systems.Working knowledge of University financial and human resources-based operating systems.Statistical analysis and data benchmarking proficiency.Experience with auditing processes.CONDITIONS OF EMPLOYMENTThe application process for UW positions may include completion of a variety of online assessments to obtain additional information that will be used in the evaluation process. These assessments may include Work Authorization, Cover Letter and/or others. Any assessments that you need to complete will appear on your screen as soon as you select "Apply to this position". Once you begin an assessment, it must be completed at that time; if you do not complete the assessment you will be prompted to do so the next time you access your "My Jobs" page. If you select to take it later, it will appear on your "My Jobs" page to take when you are ready. Please note that your application will not be reviewed, and you will not be considered for this position until all required assessments have been completed.
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