Regulatory Specialist I conducting regulatory activities for health care facilities across Florida. Prepares reports, manages files and provides support for QA reviews in the agency.
About the role
- Revenue Cycle Compliance Manager responsible for compliance programs in healthcare revenue cycle. Leading audits, managing risk, and collaborating with corporate compliance and physician leadership.
Responsibilities
- Leads the Revenue Cycle Compliance program across all professional billing operations.
- Develops and manages risk-based audit plans for coding, documentation, modifiers, and medical necessity.
- Supervises Compliance Auditors, AR Compliance Auditors and Analysts.
- Performs trend analysis of coding accuracy, denial patterns, payer audits, and reimbursement risk.
- Serves as the primary operational contact for payer audits, refunds, and external compliance reviews.
- Partners with Corporate Compliance and Legal on corrective action plans and self disclosure decisions.
- Provides compliance risk reporting to Revenue Cycle leadership and executive stakeholders.
- Collaborates with physician leadership to address documentation and coding risks.
Requirements
- Five or more years of experience in healthcare revenue cycle, coding, or auditing
- At least 3 years of experience in compliance, audit, or revenue integrity leadership
- Strong knowledge of CPT, ICD 10 CM, HCPCS, E and M guidelines, modifiers, NCCI edits, and medical necessity rules.
- Experience working with payer audits, provider audits and recoupment activity
- Prior supervisory and/or leadership experience
- CPMA
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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