Regulatory Compliance Manager
Category: Exempt
Pay Grade: E28
Job Code: 10938
To perform this job successfully, an individual must be able to perform the essential job functions satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary job functions herein described. Since every duty associated with this position may not be described herein, employees may be required to perform duties not specifically spelled out in the job description, but which may be reasonably considered to be incidental in the performing of their duties just as though they were actually written out in this job description.
JOB SUMMARY
Performs highly responsible managerial, administrative, and technical work managing the day-to-day operations of the Ambulance Billing Services and Compliance sections within the Ambulance Billing and Financial Services Division of Safety & Emergency Services; works closely with the Division Director to develop and implement policies and directives that comply with State and Federal regulations and guidelines that govern healthcare providers, specifically the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Centers for Medicare and Medicaid Services (CMS) guidance, and other related healthcare regulations.
ESSENTIAL JOB FUNCTIONS (examples, not all inclusive)
- Manages and oversees the daily business activities of the Billing Services and Compliance sections;
- Establishes goals and objectives for subordinate supervisors with an emphasis on maintaining compliance, maximizing revenue collection, and providing quality customer service;
- Provides management, support, and guidance to supervisors and subordinates related to business operations and problem resolution;
- Develops and implements a comprehensive compliance program that ensures the compatibility of the Division’s processes, procedures, and policies with all applicable healthcare regulations and guidance;
- Manages the completion, validation, and analysis of required HIPAA assessment and other related compliance assessments, including the development and implementation of action plans to address areas of identified risk;
- Interprets proposed new or revised healthcare legislation and/or procedural changes and advises senior management regarding any potential impacts to the Division’s operations and/or revenue as a result of the proposed changes;
- Works with other healthcare professionals and industry peers to identify, capture, and summarize issues impacting healthcare providers;
- Acts in an independent leadership role supporting and coordinating the activities and functions of the Pinellas County Compliance Committee;
- Identifies procedural and operational efficiencies and makes appropriate recommendations to the Division Director;
- Develops and implements strategic plans in order to address regulatory or operational changes, or departmental needs;
- Acts as a liaison and provides oversight of contracted external billing vendors;
- Prepares related analysis, reports, position papers, recommendations, and presentations;
- Ensures programmatic and operational compliance with all associated rules, regulations, and department policies;
- Acts on behalf of the Division Director in their absence;
- Performs other related job duties as assigned.
QUALIFICATIONS
Education and Experience:
Eight (8) years of progressively responsible technical, professional, and administrative experience in public administration, regulatory compliance, medical billing management, health services, or a related field that includes four (4) years of managerial experience; or a Bachelor’s degree and four (4) years of experience as described above; or a Master’s degree and two (2) years of experience as described above; or an equivalent combination of education, training, and/or experience.
Special Qualifications (May be required depending on area of assignment):
- Florida Driver’s License or Florida Commercial Driver’s License and endorsement, if any.
- Assignment to work a variety of work schedules including compulsory work periods in special, emergency, and/or disaster situations.
- May require a college degree, occupational certifications, and specialized training directly related to the position’s requirements.
- Other knowledge, skills, abilities, and credentials required for a specific position.
Knowledge, Skills and Abilities:
- Knowledge and understanding of all Billing Services and Compliance functions within Ambulance Billing;
- Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Centers for Medicare and Medicaid Services (CMS) guidance, and other related healthcare regulations and guidance;
- Knowledge of principles and techniques of effective communication;
- Skill in advanced leadership techniques and practices;
- Skill in the development of processes, procedures, workflows, and performance measures;
- Ability to evaluate and determine organizational goals and objectives;
- Ability to interpret and apply complex state, federal, and private rules and regulations pertaining to health care providers;
- Ability to manage staff and prioritize duties appropriately;
- Ability to interact effectively, establishing good working relationships with staff, healthcare professionals, other County departments, regulatory officials, stakeholders, and the general public;
- Ability to communicate effectively, both written and orally, and to make effective presentations to a variety of groups;
- Ability to apply computer applications and software;
- Ability to plan, supervise, and coordinate technical and administrative programs.
PHYSICAL/MENTAL DEMANDS
The work is sedentary work which requires exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Additionally, the following physical abilities are required:
- Feeling: Perceiving attributes of objects, such as size, shape, temperature or texture by touching with skin, particularly that of fingertips.
- Fingering: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
- Grasping: Applying pressure to an object with the fingers and palm.
- Handling: Picking, holding, or otherwise working, primarily with the whole hand.
- Reaching: Extending hand(s) and arm(s) in any direction.
- Visual ability: Sufficient to effectively operate office equipment including copier, computer, etc.; and to read and write reports, correspondence, instructions, etc.
- Hearing ability: Sufficient to hold a conversation with other individuals both in person and over a telephone; and to hear recording on transcription device.
- Speaking ability: Sufficient to communicate effectively with other individuals in person and over a telephone.
- Mental acuity: Ability to make rational decisions through sound logic and deductive processes.
- Talking: Expressing or exchanging ideas by means of the spoken word including those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
- Repetitive motion: Substantial movements (motions) of the wrist, hands, and/or fingers.
- Standing: Particularly for sustained periods of time.
- Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.
WORKING CONDITIONS
Work is performed in a dynamic environment that requires sensitivity to change and responsiveness to changing goals, priorities, and needs.