Clinic Compliance Manager

Tufts University School of Dental Medicine (TUSDM) offers one of the most forward-looking educational environments in Dental Medicine in the Country. TUSDM has established a formal institutional Compliance Program to help ensure compliance with all Federal, State and Accreditation Regulations, especially those related to Anti-Kickback, Fraud and Abuse, and HIPAA Privacy and Security Regulations. The TUSDM Compliance Program provides a structure and process to disseminate legal, regulatory and policy changes to members of the TUSDM Workforce and promote an ethical, law-abiding culture.

Due to the complex and ever-changing regulatory requirements, the Federal Government has mandated that Healthcare Providers and Covered Entities establish a Compliance Program that is charged with monitoring, preventing, and correcting any potential non-compliant actions or behavior. The Compliance Manager, along with the other members of the TUSDM Workforce and Compliance Team, supports the Compliance, Academic and Clinical Mission of TUSDM in this regard.

This position reports directly to the TUSDM Sr. Compliance Officer, and works closely with the TUSDM Workforce, particularly the Revenue Cycle department, Clinic Administration (Clinical Affairs) Coordinator and Staff, Post-Graduate Practice Managers and the Billing, Clinic and Academic Management Staff. This is a hybrid role, with an onsite presence as needed to perform the work.

The Compliance Manager will work with the TUSDM Compliance Team to develop and oversee the Compliance Audit Work Plans for the Pre-Doctoral and Post-Graduate Clinics and perform routine compliance audits of the Dental Clinics to determine medical necessity and the level of care billed for services rendered, in accordance with Medicare, Medicaid, other federal insurance programs and third-party payer regulations. The individual provides guidance, training and education and suggests corrective action plans, when applicable, to members of the TUSDM Workforce, including but not limited to, Students, Residents, Fellows, Faculty, TUSDM-sponsored Visitors, Staff and Volunteers. The Compliance Manager collaborates with Clinical Affairs, Practice Managers, the TUSDM Billing Department and other necessary entities/third party payers to identify and analyze billing, documentation and regulatory guidelines that may impact TUSDM's Compliance efforts, revenue cycle, and Academic or Research Missions.

Basic Requirements:
Knowledge and experience typically acquired by:

• Bachelor's Degree
• 7+ years of current billing and medical coding audit work within a physician/dental practice or hospital system.
• Demonstrated knowledge of insurance carriers, Medicare and Medicaid reimbursement plans, commercial dental/medical, insurance coding and billing practices (third-party billing) and dental patient care systems Familiarity with ADA (dental) codes, ICD-9/10 and CPT Codes.
• Microsoft Word, Excel, PowerPoint, Outlook, email, internet.
• Coding Instructor credentials
• Certified Dental Coder (CDC)

Preferred Qualifications:

• Familiar with Axium, Dentrix or Epic