Position Summary:

The Compliance / QA / Revenue Integrity Manager oversees and manages compliance, quality assurance, documentation review, and revenue integrity support throughout Prodigy. Essential Job Functions include those listed below. Other duties may be assigned as needed.

Essential Job Functions:

Oversees the compliance, quality assurance, and revenue integrity activities of Prodigy Healthcare, Inc.; Assists management with oversight of documentation, compliance, and quality assurance requirements; Reviews services delivered and related support documentation for completeness and consistency; Reviews services billed and related documentation for accuracy and support; Monitors quality assurance review processes and follow-up items; Reviews treatment records, progress notes, treatment plans, sign-in sheets, and related program documents; Tracks compliance-related deadlines, renewals, and corrective action items; Assists with credentialing, personnel-file compliance, training logs, and required support records; Works directly with management regarding documentation, billing, QA, and compliance matters; Assists with internal chart review, file review, and quality assurance reporting; Assists with service, billing, and documentation reconciliation as assigned; Maintains compliance, QA, and revenue integrity support files; Assists with month-end and year-end review activities related to documentation and billing support; Tracks services delivered, services billed, and related support information; Assists with review of documentation, billing questions, and follow-up items as assigned; Maintains schedules, worksheets, and compliance reports; Assists with program, billing, and quality assurance review processes; Helps prepare audit, fiscal review, and regulatory review documents; Works with management to identify documentation, billing, or compliance issues and needed corrections; Assists with policy, procedure, and training support as assigned; Helps maintain organized compliance and quality assurance recordkeeping systems; Maintains confidentiality of client, employee, and company information; Communicates with leadership and outside professionals regarding compliance and QA matters; Other relevant duties as assigned.

Essential Qualifications:

Five (5) years experience in management in an outpatient SUD setting; LiveScan fingerprint clearance; Annual Tuberculosis test and health screening; Valid California Driver's license and automobile insurance; Compliance / QA / Revenue Integrity Manager Job Description Basic knowledge of documentation review, compliance, quality assurance, and billing support.

Education:

Bachelors Degree in Business Administration or related field.

Working Conditions:

• The normal work routine involves no exposure to blood, body fluids, or tissues, BUT exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be readily available to every employee engaged in Category II tasks;
• On-site work will be performed in office or treatment facility;
• Considerable part of the job will include computer-based work, review of program, billing, and compliance records, and communication with management and staff; and
• Position will include occasional contact and interaction with clients.

Physical Demands:

• The normal work routine involves no exposure to blood, body fluids, or tissues, BUT exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be readily available to every employee engaged in Category II tasks;
• Occasional lifting of more than 10 pounds; and
• Sitting, standing, walking, reaching, computer work, and review of program, billing, and compliance records are performed in the normal course of the position.

Pay:

$80,000.00 - $120,000.00 per year

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person