Lab Billing Compliance Manager

Remote (United States)

Color is a health technology company that makes population-scale healthcare programs accessible, convenient, and cost-effective for everyone. We have raised $100 million in Series E funding, bringing our valuation to $4.6 billion and our total raised amount to $378 million. We work with governments, public health institutions, employers, and national health initiatives around the world to provide the tools for preventive health and infectious disease management, including testing, vaccinations, and other services.

Apply to join Color and do the most meaningful work of your career. If you are not sure that you’re 100% qualified but are up for the challenge - we want you to apply!

What we offer:

💰 Competitive salary
✨ Comprehensive medical, dental, vision, life, and disability benefits. Including employer HSA contributions.
📈 401k match
📝 Monthly lunch, phone, and wifi stipend for remote employees
🏝 Generous vacation policy, paid holidays, and company-wide recharge days
💌 Monthly stipend to spend on your well being
🍼 Equal paid parental leave for birthing and non-birthing parents
🧬 Four complimentary clinical-grade genetic testing kits for you and your familyv

Under the direction of the VP, Chief Compliance Officer at Color and in support of the Chief Legal Officer, this position will lead the development, coordination, and implementation of a Lab Billing Compliance Program and delegate oversight activities with contracted health plans, entities, and vendors.

How You’ll Contribute:

Develop a lab billing compliance program and ensure that the plan is implemented and enforced.
Develop tools to conduct compliance monitoring and help develop metrics to track the overall effectiveness of the compliance program.
Implements, and maintains policies and procedures to ensure compliance with billing and coding standards and regulations.
Monitor business activities for compliance when regulations change, support departments and company strategies to ensure compliance with federal, State, and contractual healthcare requirements.
Prepare for audits and the development of reports/tools to monitor and track implementation and completion of corrective measures. Supports the compliance team on general standards of conduct; fraud, waste and abuse; OIG; and HIPAA-related matters.
Research and interpret complex policies regarding government programs requirements and maintain tracking of all delegation oversight activities from contracted delegated health plans, entities and vendors. Assist in monitoring OIG sanction checks.
Document and analyze changes across departmental policies when modifications are required due to audit findings and/or regulatory changes. Collaborate on drafting new billing compliance policies (for both Medicare/Medicaid and private insurance) and updating existing policies as required to ensure regulatory compliance, including for identifying and addressing any billing issues.
Implement measures sufficient to confirm the medical necessity of ordered tests.
Oversee any third-party billing administrators to ensure compliance.
Understand and review use of relevant CPT codes and be able to recommend appropriate codes to use.
Be fluent in and stay current with federal and state fraud and abuse laws and regulations.
Lead efforts to ensure all relevant personnel are adequately trained on billing.
Lead internal billing compliance audit efforts, including documenting a protocol for responding to billing compliance audits.
Ensure sufficient document retention of audits and billing compliance.
Track and trend areas of compliance and regulatory vulnerability and risk within the organization and assist in developing solutions to enhance processes.

Our Ideal Candidate Will Have:

Bachelor's Degree preferred and a minimum of 8 years of related experience in compliance, regulatory-government programs, preferably with direct experience dealing with interpreting and applying complex Medicaid and Medicare rules and policies in a healthcare administration setting.
Knowledge of Medicaid, Medicare and Medical regulations applicable to health plans.
Effectively and respond accurately to questions from business departments, outside agencies and vendors, and Management.
Strong reasoning, problem-solving, project management and organization skills, with a high level of attention to detail.
Excellent verbal/written communication, relationship-building and time management skills.
Excellent technical writing skills with the ability to draft policies in a clear, concise manner.
Ability to adapt to changing priorities and to manage various projects simultaneously.
Ability to independently on assigned projects.
Working knowledge of DHCS, DMHC and CMS requirements.
Strong communication and interpersonal skills essential to this role.

Nice to Have:

Certified Coding Specialist (CCS) and Certified in Healthcare Compliance (CHC) - Health Care Compliance Association (HCCA)

Color is an equal opportunity employer. In accordance with anti-discrimination law, it is the purpose of this policy to effectuate these principles and mandates. Color prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability status, protected veteran status, or any other characteristic protected by law. Color conforms to the spirit as well as to the letter of all applicable laws and regulations. We are also committed to providing reasonable accommodations for qualified applicants with disabilities in our recruitment process.

Mandatory Vaccination Policy Disclosure

COVID-19 Vaccination Requirement: Color requires anyone working onsite or visiting Color’s offices to confirm they are fully vaccinated against COVID-19 unless a medical or religious accommodation is timely requested and approved. Please reach out if you have questions or concerns about this policy and how it may apply to your candidacy for a role with Color.