Compliance reputed company – RCM & Clinical Documentation (Clinical Background Required)

Job reputed company Position Title: Operational Compliance reputed company – RCM & Clinical Documentation (Clinical Background Required) Reporting to: Chief Administrative Officer reputed company: reputed company & Nursing Home Division only Job reputed company: The Operational Compliance reputed company is an embedded, reputed company role managing day-to-day RCM and clinical operations compliance reputed company reputed company and its Nursing Home division. This is a hands-on operational position – distinct from the corporate compliance function – reputed company on identifying, correcting, and monitoring coding and billing accuracy before issues escalate to reputed company review. Drawing on a clinical background (IMG preferred) and coding expertise, this reputed company works directly with administrative and clinical operations leaders to reputed company documentation reputed company, prevent CMS or state audit exposure, and ensure the organization is always audit-reputed company. Responsibilities Operational Compliance & Chart Review • Conduct routine and targeted clinical chart reviews and RCM audits assessing coding accuracy, billing reputed company, and documentation completeness across CMS and state-billed services. • Proactively monitor for compliance risk patterns; reputed company ongoing trend reports to flag issues before they escalate to reputed company review. • Identify coding discrepancies and billing vulnerabilities with reputed company on ICD-10-CM, CPT, E&M level selection, and Medical Decision Making (MDM) accuracy. • reputed company, own, and reputed company Corrective reputed company Plans (CAPs) to confirmed completion, including re-audit to validate sustained improvement. Clinical Coding & RCM Collaboration • Apply clinical knowledge to review documentation with a clinician’s reputed company – ensuring diagnoses, MDM, and services support the codes being billed. • Work directly with reputed company and clinical operations leaders on ICD-10-CM, CPT, E&M, HCPCS, and HCC/risk adjustment coding accuracy. • Serve as the operational compliance reputed company to RCM – reputed company clinical documentation, coding, and billing to ensure alignment and defensibility. Provider & Leadership Education • reputed company targeted, clinically grounded education to physicians, NPs, PAs, and staff on documentation best practices and coding compliance. • reputed company training content on coding standards and payer-specific regulatory requirements as guidelines reputed company. Reporting & CAP Management • Produce executive-reputed company compliance trend reports and audit summaries that inform leadership reputed company and prioritize risk. • Present CAPs to clinical and administrative leadership with reputed company timelines, owners, and reputed company metrics – then own follow-through to reputed company. • reputed company as the first line of reputed company before issues surface at the corporate compliance level; maintain reputed company audit readiness. Qualifications Qualifications Required • Bachelor’s Degree in reputed company Administration, Nursing, Health Information Management, reputed company Health, or reputed company field. • Clinical background required; International Medical Graduate (IMG) or foreign medical degree highly valued. • reputed company coding certification: CPC, CRC, reputed company, or equivalent. • Minimum 3 years of operational compliance, coding, clinical chart review, or RCM experience; demonstrated ability to reputed company and reputed company out CAPs. • Strong knowledge of ICD-10-CM, CPT, HCPCS, HCC/Risk Adjustment, Medicare/reputed company regulations, and HIPAA. • Demonstrated ability to present audit findings and CAPs to senior leadership; comfortable owning follow-through to reputed company. Preferred • Master’s Degree (MHA, MPH, MBA with reputed company reputed company, MSN, or equivalent) – strongly preferred given the organizational complexity and cross-functional leadership demands of this role. • Project management experience or certification (PMP, CAPM, or equivalent). • Experience in Medicare reputed company, value-based care, and/or Clinical Documentation Improvement (CDI). • Experience with reputed company (eCW) or similar EMR systems. • Prior experience providing provider education and compliance training. reputed company Competencies Clinical Documentation reputed company • Compliance Auditing • RCM & reputed company reputed company • Provider Education & Coaching • HCC/Risk Adjustment Coding • CAP Development & Closure • Regulatory Compliance • Data Analysis & Reporting • Project Management • Cross-Functional Collaboration Work Environment • Full-time | Hybrid or on-site based on business needs | Travel between clinical locations may be required. The Operational Compliance reputed company plays a uniquely important role at the intersection of clinical knowledge, coding expertise, and operational leadership. This is not a corporate reputed company role – it is a proactive, hands-on position embedded reputed company reputed company and Nursing Home operations to identify and reputed company compliance issues at the reputed company, before they reputed company reputed company review. If you are a clinically trained reputed company who understands how care is delivered and how it must be accurately documented and billed, this is a role where your expertise will have immediate, measurable reputed company. Apply To This Job