Hartford Healthcare

Primary Location

: Connecticut-Hartford-100 Pearl Street Hartford (10484)

Job

: Legal / Compliance

Organization

: Hartford HealthCare Corp.

Job Posting

: May 22, 2025

Program Mgr Revenue Compliance / Compliance and Privacy - (25157104)

Description

Work where every moment matters.

Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Reporting to the System Director of Revenue Compliance, the Program Manager of Revenue Compliance contributes to the success of OCI through managing system-wide revenue compliance initiatives, activities and projects, including drafting and managing the annual system-wide revenue compliance auditing and monitoring plan. Develops and oversees implementation of annual revenue compliance plans, training, auditing and monitoring programs, policies and procedures.

This role has a specific focus on revenue compliance risk areas including, but not limited to, facility and professional billing, short stays, medical necessity, clinical documentation improvement, credentialing, billing requirements for teaching physicians/residents, ABN process, partial hospitalization, home care, inpatient rehabilitation, and others. In addition, the Program Manager of Revenue Compliance will have a firm understanding of the Medicare IPPS, OPPS and ASC payment system.

Works to develop strong relationships with key stakeholders in Revenue Cycle, Coding, Health Information Management, Information Technology, and various clinical and non-clinical departments across the System. Works closely with OCI leadership to develop, implement and maintain revenue compliance initiatives, projects and processes. Serves as a role model for ethical management behavior and promotes an awareness and understanding of the System’s Code of Conduct and Corporate Compliance Program. Advocates for compliant business practices and serves as a resource to the system regarding revenue compliance questions. Staffs and facilitates revenue compliance and other related meetings as required.

The Program Manager of Revenue Compliance may also serve as on OCI liaison to a respective Region or Network of HHC. In the role of OCI liaison, develops strong relationships with, and reports periodically to, the Executive Leadership Team (ELT) of the respective Region(s) and/or Network(s).

Position Responsibilities:

Key Areas of Responsibility

1. Manages System-wide revenue compliance initiatives, projects and audits per the OCI Work and Audit Plan, developing strong working relationships with system management, employees and key stakeholders. Performs chart to bill audits in various areas and specialties to evaluate processes and controls in place to provide for accurate charge capture and billing procedures

2. Leverages data to perform ongoing monitoring and risk assessment activities. Recommends strategies designed to proactively manage and mitigate risk.

3. Investigates, as appropriate and necessary, allegations of inappropriate billing activities and manages all HHC revenue compliance investigations, reporting on investigative results. Has access to all documents, staff, meetings and other information that is relevant to revenue compliance and audit activities.

4. Responsible for the integrity of the compliance incident reporting system and investigation database and all related data and content as it relates to revenue compliance activities.

5. Develop, implement, promote and maintain revenue compliance and audit policies and procedures relevant to the System.

6. Teach, coach and mentor Revenue Compliance Auditors and Senior Revenue Compliance Auditors through the review and validation of any work performed by those team members. Provide constructive feedback when necessary and collaborate to improve overall team performance.

7. Participates in committees and work groups addressing revenue compliance or audit related subject matter.

8. Maintain current knowledge of applicable federal and state laws and other regulations and accreditation standards, and monitor advances in revenue compliance and audit standards and changes in regulations to ensure organizational adaptation and compliance. Participate in outside healthcare compliance organizations to stay abreast of developments and best practices within the industry.

9. Review fraud alerts, regulatory advisories, and enforcement actions issued by regulatory oversight agencies. Perform risk assessments and provide education and guidance based on these publications.

10. In the capacity of the OCI liaison to an HHC Region or Network, develops and maintains strong working relationships with Leadership and prepares quarterly reports to the Regional or Network ELT and keeps leadership in the Region or Network appraised of compliance-related activities and investigations impacting that region.

Working Relationships:

• This Job Reports To: System Director, Revenue Compliance
• Describe nature of supervision of any External workers (e.g. vendors, contractors): Consultant engagements as assigned.

Qualifications

Education

• Minimum: Bachelor’s degree is required.
• Preferred: Advanced Degree is preferred.

Experience:

• A minimum of six years of health care compliance experience, preferably in a large Healthcare system setting or in a consulting capacity.

Licensure, Certification, Registration

• Minimum: CHC, CCEP
• Preferred: CMAS, CPMA, CPC, RHIA

Knowledge, Skills and Ability Requirements:

• Knowledge of healthcare compliance programs and Office of Inspector General guidance and related Federal and State healthcare laws required.
• In-depth knowledge of complex Medicare billing regulations; significant experience with Medicare/Medicaid, strong knowledge of CPT, HCPCS and ICD-10 coding and healthcare reimbursement systems.
• Demonstrated leadership skills and ability to interact and build relationships with all levels of staff.
• Ability to research and interpret regulatory requirements and coordinate and monitor internal responses to complaints, audits and investigations.
• Demonstrated organization, facilitation, communication and presentation skills.
• Ability to prioritize, plan and work independently.
• Ability to analyze complex problems and develop effective solutions for correction.
• Ability to effectively work with and coordinate the activities of outside consultants and legal counsel.
• Ability and skills to influence personnel through a matrix organization as opposed to line management authority.
• High level of integrity and trust

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

Regular

Standard Hours Per Week: 40

Schedule: Full-time (40 hours)

Shift Details: Monday to Friday 8:30-5

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