Regulatory Compliance Manager

Regulatory Compliance Manager

Do you possess expertise in management in an Ambulance billing environment, working with compliance regulations and HIPAA? Pinellas County Department of Safety & Emergency Services, Financial Services Division, has the ideal job for you!!

Performs highly responsible managerial, administrative, and technical work managing the day-to-day operations of the Ambulance Billing Services and Compliance sections within the Ambulance Billing and Financial Services Division of Safety & Emergency Services; works closely with the Division Director to develop and implement policies and directives that comply with State and Federal regulations and guidelines that govern healthcare providers, specifically the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Centers for Medicare and Medicaid Services (CMS) guidance, and other related healthcare regulations.

This Regulatory Compliance Manager position is located at : 12490 Ulmerton Road, Largo, FL 33774. Work Schedule : Monday - Friday, 8 a.m. - 5 p.m.

Must be able to pass and maintain a CJIS Level 2 Background Check

What Will You Do?

Manage and oversee the daily business activities for five distinct Sections of Financial Services Division : Billing Services, Accounts Receivable, Compliance, Program Services, and Contracting Revenue Enhancement. Ensure the proper and consistent application of the County's Human Resources Rule, inclusive of the disciplinary process and internal Department policies by Financial Services managers and supervisors.

Work with Section Managers to develop and maintain performance measures that align with the goals and objectives of the Division / Department.

Establish goals and objectives for subordinate supervisors with an emphasis on maintaining compliance, maximizing revenue collection, and providing quality customer service.

Provide management, support, and guidance to supervisors and subordinates related to business operations and problem resolution.

Develop and implement a comprehensive compliance program that ensures the compatibility of the Division's processes, procedures, and policies with all applicable healthcare regulations and guidance.

Manage the completion, validation, and analysis of required HIPAA assessment and other related compliance assessments, including the development and implementation of action plans to address areas of identified risk.

Interpret proposed new or revised healthcare legislation and / or procedural changes and advises senior management regarding any potential impacts to the Division's operations and / or revenue as a result of the proposed changes.

Work with other healthcare professionals and industry peers to identify, capture, and summarize issues impacting healthcare providers.

Actively engage with the Florida Ambulance Association (FAA), the American Ambulance Associate (AAA), and professional partners on regulatory issues and barriers crucial to ambulance medical service providers.

Act in an independent leadership role supporting and coordinating the activities and functions of the Pinellas County Compliance Committee.

Identify procedural and operational efficiencies and makes appropriate recommendations to the Division Director. Acts on behalf of the Division Director in their absence.

Develop and implement strategic plans in order to address regulatory or operational changes, or departmental needs.

Act as a liaison and provides oversight of contracted external billing vendors and serves as the first point of contact to handle elevated patient complaints associated with billing.

Lead actions and Division deliverables on issues associated with public or private insurance carriers that evaluate to a formal complaint and / or legal action, e.g., litigations related to the underpayment by HMO plans failure to comply 631.513(5) (in coordination with County Attorney's Office); formal complaints filed with the Agency for Healthcare Administration (AHCA), etc. Prepare related analysis, reports, position papers, recommendations, and presentations.

Ensure programmatic and operational compliance with all associated rules, regulations, and department policies.

Oversee the execution of contracts, settlements, and litigation in coordination with County Legal associated with AHCA's MMA Plans / brokers, hospitals, skilled nursing facilities, and public / commercial payers for Department administrative review.

Make the determination as to the appropriate next step for issues related to public and private insurance carriers that may be of a legal nature and summarize for presentation and recommendation at the Department's routine legal Meeting.

Interpret complex Federal / State regulations to develop active application processes for the work functions of the Division. Inclusive of new healthcare rules / regulations, proposed rule changes, and requirements for specific funding / programs / agreements, e.g., COVID Act Coronavirus Relief Fund (CARES) funding and programs (uninsured). Oversee, manage, and negotiate the collection method associated with large entity accounts (hospital, skilled nursing facilities, Hospices etc.) with significant reimbursement backlogs.

Performs other related job duties as assigned.

What Do You Need?

Experience : Responsible technical, professional, and administrative experience in public administration, regulatory compliance, medical billing management, health services, or a related field that includes four (4) years of managerial experience.

• 8+ years' experience as described above.
• Associate's degree and 6+ years of experience as described above.
• Bachelor's degree and 4+ years of experience as described above.
• Master's degree and 2+ years of experience as described above.
• An equivalent combination of education, training, and / or experience.
• Florida Driver's License at time of hire.
• Assignment to work a variety of work schedules including compulsory work periods in special, emergency, and / or disaster situations.

Why Choose Pinellas County?

When you join Pinellas County, you're not just taking on a jobyou're investing in your future. We believe in supporting our employees with exceptional benefits that help you thrive both professionally and personally. Here's why our benefits stand out as some of the best in the area :

Review the full classification description with the Knowledge / Skills / Abilities, Physical / Mental Demands and Working Conditions at the link below.