Supervisor Research Billing Compliance

Orlando, Florida, Description All the benefits and perks you need for you and your family: · Benefits from Day One · Sign-on Bonus* · Paid Days Off from Day One · Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense) Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that  together  we are even better. Schedule:  Full Time, Days Shift :    Monday – Friday The community you’ll be caring for: ·        Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando ·        We offer great benefits with immediate Health Insurance coverage ·        Career growth and advancement potential ·        Serves as the major tertiary facility for much of the Southeast, the Caribbean and South America ·        AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country ·        We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year The role you’ll contribute:  AdventHealth Research Institute (AHRI) provides corporate level research oversight across all markets to ensure that research is performed in a consistent manner that is in full alignment with all applicable federal, state, and local rules and regulations. The Supervisor-Research Billing Compliance is integral to the effectiveness and success of the Research Compliance Program of the AdventHealth Research Institute (AHRI) with responsibilities for compliant billing practices and processes at the corporate level for research participants for hospital billing and professional billing system wide. This is accomplished through ensuring that essential research billing policies and procedures are implemented, research billing education and training is effective, research billing processes for research participants are monitored regularly, and that billing related inquiries are addressed. Primary efforts and responsibilities are centered on the prevention, detection and reporting of Medicare Fraud and Abuse. The Supervisor-Research Billing Compliance operates independently and has direct reporting and supervisory responsibility for the following positions, Research Compliance Analyst Monitor-Research Billing Integrity and Research Compliance Analyst II- Research Billing Integrity.

The Supervisor-Research Billing Compliance participates in and oversees the team members conducting internal compliance reviews and quality assurance/quality improvement monitoring to assess compliance with federal and state laws, regulations, guidance, and standards, as well as AHRI Policies & Procedures related to research billing integrity and compliance. The Supervisor-Research Billing Compliance ensures findings are recorded and that reports of findings are submitted to all appropriate parties and leads the team in Corrective and Preventative Action (CAPA) plan development. The Supervisor-Research Billing Compliance will prepare and provide any requested and/or required reporting to the AdventHealth Research Council (ARC), Research Oversight Committee (ROC), Corporate Compliance, and AHRI senior leadership and work collaboratively with Corporate Compliance to ensure research billing compliance and integrity. The value you’ll bring to the team: ·            Develops corporate-wide annual monitoring work plan for research billing as part of the ongoing risk assessment of the AHRI Research Compliance Program effectiveness as it relates to research billing compliance and integrity. ·            Leads and executes project plans and steps related to the improvement of the Research Compliance Program and the annual Research Compliance Risk Assessment initiatives. ·            Leads team to work collaboratively with AHRI Directors and managers to identify, prioritize, schedule and coordinate compliance and monitoring reviews of research billing processes. ·            Supervises team to independently conduct onsite and/or virtual internal compliance reviews of research billing practices and processes to assess compliance with applicable federal and/or state regulations, CMS and applicable AdventHealth (AH)/AHRI Policies and Procedures related to research billing. Conducting onsite reviews will occasionally require travelling to various AH markets, divisions and/or campuses across the country. ·            Ensures the research billing compliance team documents findings objectively via a compliance review and monitoring report, identifying required actions to attain compliance in a thorough and concise manner and that it is delivered to all responsible team members. ·            Responsible to ensure team conducts follow-up of action required items identified in compliance reviews, ensuring the appropriate individual(s), department, and/or team completes the required actions within the identified timeframe as outlined in the compliance and monitoring review report until resolution of all required actions is achieved.

·            Accountable for the review, analysis, and completion of results of compliance reviews and activities and for the preparation of reports detailing the findings including aggregate information for enterprise and metrics reports. ·            Leads research departments, research investigators and study teams in conducting root cause analysis and development of corrective and preventative action plans (CAPAs) resulting from compliance review results and activities. ·            Leads in the development and revision of AHRI policies as well as standard operating procedures (SOPs) as they relate to research billing. Conduct yearly review of existing research billing policies and SOPs and facilitate revisions as needed. ·            Develops and promotes activities to foster effective communication and information deployment regarding AHRI policies and SOPs and research billing compliance awareness within AH. ·            Develops, provides and/or selects content for AHRI educational presentations related to research billing compliance topics working collaboratively with the Research Training and Education Manager. ·            Conducts and provides education and training opportunities, presentations, etc. (live in-person, online, and/or recorded sessions) related to all research billing topics including, regulations, practices, processes, AHRI policies & procedures. ·            Responsible for ensuring all research billing inquiries, complaints and/or concerns are adequately investigated and appropriately addressed working collaboratively with Corporate Responsibility when circumstances require. ·            Provides expert opinion and counsel to research leadership and serves as a resource and Subject Matter Expert (SME) to AHRI research departments and individual research team members regarding issues related to research billing compliance.

·            Keeps abreast of appropriate regulatory, Centers for Medicare and Medicaid Services (CMS) and legislative changes and the annual Office of Inspector General (OIG) Workplan that may affect current job functions and areas of responsibility. ·            Maintains professional growth and development including professional certifications. Attends educational offerings to remain current in area of expertise. Qualifications The expertise and experiences you’ll need to succeed: KNOWLEDGE AND SKILLS REQUIRED: ·        Expert knowledge of complex federal rules, regulations and standards applicable to clinical research billing including Medicare Fraud and Abuse laws, the False Claims Act, Stark Law, Anti-Kickback Statute, Centers for Medicare and Medicaid Services (CMS) rules and policies including the Medicare Clinical Trials Policy – National Coverage Determination (NCD) for Routine Costs in Clinical Trials, and Medicare Benefit Policy Manual, Ch. 14 for investigational devices, and Local Coverage Determination (LCD) decisions related to clinical trials billing. Expertise in the concepts of routine costs versus research related costs, research budget build, Medicare coverage analysis (MCA), research billing grids, Clinical Trial Management System (CTMS) builds of study calendar and study type, cost sharing, time and effort, indirect costs or overhead, research document concordance, and fair market value (FMV) as related to clinical research and research billing. Expertise in recognizing noncompliance with federal regulations, escalating research billing integrity and compliance issues when suspected to be systemic in nature or as directed. Expertise in the Research Billing Review process in Epic application. Working knowledge of the conduct of human subject research. Ability to develop and implement compliance monitoring plans.

Analytical and critical-thinking skills are necessary to anticipate and identify potential problems and for problem solving. Proficiency in Microsoft Office Suite, particularly Outlook, Word, and Excel. Ability to maintain strict confidentiality of employees, other research team members, patients, research subjects and institution information. Ability to recognize a high standard of ethics in research operations.   KNOWLEDGE AND SKILLS PREFERRED: ·        Knowledge of electronic research management systems for IRB (Institutional Review Board) management, clinical research management, and/or grants management, especially IRBNet and Clinical Conductor. EDUCATION AND EXPERIENCE REQUIRED: Bachelor’s degree in healthcare (healthcare finance, medical coding, administration or research-related field); AND Seven years of work experience in healthcare billing, medical coding or revenue cycle, with at least 2 years of clinical research billing and/or research billing compliance. Auditing/monitoring of billing practices in a healthcare system. Experience in supervising or managing employees. Experience in independently conducting detailed and thorough analysis and compliance reviews of research billing practices and processes. Experience in identifying process improvement opportunities and provide recommendations and/or implement new processes.

·        Experience in public speaking, teaching, and development of training materials.   EDUCATION AND EXPERIENCE PREFERRED: ·        Master’s degree in healthcare, administration, finance, or research-related field. ·        Prior experience in research (clinical trials) or grants (pre-award or post-award) ·        Experience in area of medical coding, denials or revenue cycle management in a medical practice or hospital setting. ·        Experience working with outside counsel and external auditors. This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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