Compliance Senior Manager
The Compliance Senior Manager has a broad understanding of billing compliance as it relates to Private Payer, Federal and State regulations and ensures that all genetic test coding and reimbursement practices, clinical documentation monitoring, reviews, education and training are in full compliance with regulations. The Compliance Senior Manager also has experience in general healthcare compliance matters, particularly as they relate to federal Medicare, Medicaid, Fraud, Waste and Abuse laws, including but not limited to OIG, Stark, and Anti-Kickback Statutes and all other applicable regulations, including the development of general compliance policies and procedures, training, and auditing.
- Expands and develops all compliance program policies and employee training content with a particular focus on billing compliance and ensures successful execution for organization-wide compliance training.
- Ensures accurate coding of laboratory services according to CPT, HCPCS, ICD-10-CM guidelines, compliance department policies, and other corporate requirements.
- Performs monitoring activities including focused and general audits on all assigned areas based on risk profiles of the company. Maintains, communicates and executes a schedule of regular monitoring activities.
- Leads or participates in billing risk mitigation plans to address any identified compliance gaps.
- Supports the billing department with: CPT coding and billing reimbursement advice and assistance, government and commercial payer inquiries, internal audits, prepayment reviews and recoupments, management of 3rd party billing and coding audits, monitoring and analyzing trends in claim submissions to identify payment inconsistencies or errors and the corresponding corrective actions, and identification of areas where training and education are needed.
- Reviews and resolves compliance policy exception requests related to billing inconsistencies and errors from patients, customers, third-party institutions, and other team members.
- Conducts regulatory research to maintain expertise and support compliance training and education related to Federal, State and local laws and regulations, enforcement initiatives, third party coding, billing and claims submission, financial arrangements with physicians, conflicts of interest and internal policies and procedures.
- Promotes compliance initiatives and awareness throughout GeneDx. Works with the Compliance and the Executive Leadership teams in identifying areas where training and education are needed and develops appropriate materials and information to support the overall Compliance Program.
- Assists in cooperation with Federal and State regulators, legal entities, organization officers, or board of directors during compliance reviews or investigations.
- Develops, gains approval for and implements a range of general compliance policies and procedures, including annual revisions and tracking.
- Develops, implements and reviews for effectiveness general compliance employee training.
- Other duties as assigned by leadership.
*Note that this is not an exhaustive list; the employee will be responsible for other duties as assigned.
- Bachelor’s degree plus at least 3-5 years relevant work experience, Master's degree preferred.
- 5+ years’ experience with billing compliance management in a healthcare setting, preferably a genetic testing laboratory.
- Expertise with coding for genetic testing services using Next Generation Sequencing (NGS).
- Knowledge of state and federal Medicare, Medicaid, Fraud, Waste and Abuse laws, including but not limited to OIG, Stark, and Anti-Kickback Statutes and all other applicable regulations.
- Excellent written and oral communication skills.
- Strong work ethic with attention to detail.
- Ability to excel in a fast-paced and rapidly changing environment.
- Certified Professional Coder (CPC) and/or Certified in Healthcare Compliance (CHC) and/or other healthcare industry related credential preferred.
Science - Minded, Patient - Focused.
At GeneDx, we create, follow, and are informed by cutting-edge science. With over 20 years of expertise in diagnosing rare disorders and diseases, and pioneering work in the identification of new disease-causing genes, our commitment to genetic disease detection, discovery, and diagnosis is based on sound science and is focused on enhancing patient care.
Experts in what matters most.
With hundreds of genetic counselors, MD/PhD scientists, and clinical and molecular genomics specialists on staff, we are the industry’s genetic testing experts and proud of it. We share the same goal as healthcare providers, patients, and families: to provide clear, accurate, and meaningful answers we all can trust.
SEQUENCING HAS THE POWER TO SOLVE DIAGNOSTIC CHALLENGES.
From sequencing to reporting and beyond, our technical and clinical experts are providing guidance every step of the way:
- High-quality testing: Our laboratory is CLIA certified and CAP accredited and most of our tests are also New York State approved.
- Advanced detection: By interrogating genes for complex variants, we can identify the underlying causes of conditions that may otherwise be missed.
- Thorough analysis: We classify variants according to our custom adaptation of the most recent guidelines. We then leverage our rich internal database for additional interpretation evidence.
- Customized care: Our experts review all test results and write reports in a clear, concise, and personalized way. We also include information for research studies in specific clinical situations.
- Impactful discovery: Our researchers continue working to find answers even after testing is complete. Through both internal research efforts and global collaborations, we have identified and published hundreds of new disease-gene relationships and developed novel tools for genomic data analysis. These efforts ultimately deliver more diagnostic findings to individuals.
Learn more About Us here.
Essential on-site and customer facing employees may be required to provide proof of COVID-19 vaccinations. Medical or religious exemptions considered.
- Paid Time Off (PTO)
- Health, Dental, Vision and Life insurance
- 401k Retirement Savings Plan
- Employee Discounts
- Voluntary benefits
GeneDx is an Equal Opportunity Employer.