Quality and Compliance Manager

Job Description

Reports to: President

Job Summary:

This position is responsible for overseeing the day-to-day activities of the company related but not limited to compliance, quality, billing and EMR ensuring the organization is performing efficiantly and effectively. This role will also serve as a integral member of the Minnesota Hospice leadership team.

Supervisory Responsibilities:

• Responsible for managing, directing and supervising the following disciplines: Compliance and Quality Assurance RN, Quality Data Review Analyst and Quality Data Analysis.
• Responsible for staff performance, retention and development.

Duties/Responsibilities:

• Monthly processing of hospice claims including: CAHPS, Revalidation, Medical Visit Summary, etc.
• Reports: CAP, Annual Cost Reports, Batching of Admission/Discharges
• Compliance and regulatory requirements: QAPI, Safety and Infection Control
• Maintain company policies and procedures
• Monitor eligibility status on new admissions- verify benefit periods and payor sources
• Ensure admission and discharges are completed to meet CMS standards
• Assist with all patient certifcations and patient recertifications to ensure compliance with CMS standards
• Maintain good standing with in-network insurance providers
• Oversee education and training to all staff regarding survey preparedness, CAHPS results, etc.
• Oversee the emergency preparedness plan
• Participate in all staff and oversee IDT meeting compliance
• Conduct audits on patient charts to ensure proper documentation and care plans are completed receiving regular departmental audit reports to ensure survey readiness
• Contribute to annual requirements per regulatory guidelines
• Serve as a resource for EMR questions and trainings
• Responsible for communicating the requirements to maintain the 5 star Medicare rating
• Coordinate company and provider credentialing with payors
• Manage and maintain vendor contracts and ongoing projects
• Oversight of revenue cycle management processes including timeliness of billing submissions

Required Skills/Abilities:

• Knowledge of CMS regulations and guidelines of hospice and palliative care
• Experienced in EMR systems
• Competent in all Microsoft programs
• Knowledge of billing of hospice services
• Knowledge of insurance eligibility

Education and Experience:

• Current Minnesota nursing license
• Minimum of an Associate degree in Nursing, Bachelors degree preferred
• Minimum of 3 years direct support hospice experience
• Preferred compliance/regulatory certification
• Requires experiane in interpretation of raw data and comparative analysis

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift 15 pounds at times

Company Expectations:

• Adheere to all Minnesota Hospice policies and procedures
• Promote teamwork
• Lead by example
• Conduct yourself in a positive, confident and professional manner
• Communicate clearly, consisely and accurately
• Promote the hospice concept within the communities we serve
• Offer a willingness to participate in Minnesota Hospice team building and community events

Minnesota Hospice is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Interested in this Position?

Email your resume using the email link below, be sure to indicate which position you are applying.