Job Details:

Job Summary:

The Network Manager, Billing Compliance, is responsible for leading and managing billing compliance operations across the health system. This role ensures that professional and ancillary billing practices comply with federal and state regulations, payer requirements, organizational policies, and industry standards. The Network Manager develops and oversees compliance programs, auditing and monitoring activities, education initiatives, corrective action plans, and cross-functional collaboration efforts designed to reduce compliance risk and support accurate reimbursement. Specific duties include managing and overseeing prospective and retrospective audits/external reviews of documentation and coding and working with providers and staff to ensure the accuracy and completeness of the medical record. Oversee training, education and coaching of providers and staff regarding documentation and coding in compliance with Centers for Medicare and Medicaid (CMS) documentation and coding regulations.

Responsibilities:

• Manage system-wide billing compliance programs and monitoring activities while ensuring adherence to CMS and state regulatory requirements.
• Direct routine and targeted billing audits for professional, hospital, and ancillary services
• Analyze and quality assess audit findings to identify trends, risks, and opportunities as well as to provide feedback to staff and internal leaders.
• Oversee corrective action plans and monitor effectiveness of remediation efforts.
• Monitor regulatory and payer policy changes that may impact billing and reimbursement practices.
• Support external audits, government inquiries, and payer investigations while collaborating with leaders across various departments to ensure timely and compliant response.
• Develop and deliver billing compliance training programs for revenue cycle staff, providers, managers, and operational leaders.
• Lead and mentor a team of compliance analysts, auditors, and specialists.
• Promote and establish departmental goals while improving staff key performance indicators.

Experience:

• 5 years of experience in billing compliance, required
• 3 years of leadership or management experience with a team of at least three to five people, required
• Experience within a large academic medical center, preferred.

Education:

• Bachelor's Degree in related field, required

Licenses / Certifications:

• American Academy of Professional Coders – Certified Professional Coder (CPC), required

• Ability to lead and influence change without conflict
• Excellent communication and presentation skills
• Proficiency with compliance audits, guidelines and regulations
• EPIC/MD Audit/Navex/Cerner/Workday/Teams

About Us:

NorthEast Provider Solutions Inc.