Quality & Compliance Manager

1 FTE (40 hours per week)

Reports to Admin & Ops Director

About SisterLove

SisterLove, headquartered in Atlanta, GA, and with offices in South Africa, has been at the forefront for 33 years of racial justice, reproductive justice, women’s rights, and human rights as defined by The Declaration of Human Rights and environmental justice. We work with leading organizations such as Gilead Sciences, Merck, ViiV Healthcare (GSK), Janssen, the CDC PePFAR, UNAIDS, Emory University, Ford Foundation, Elton John Aids Foundation (EJAF), Planned Parenthood, John Snow, Inc. (JSI), MAC Aids Fund, amfAR, and many others.

OVERVIEW:

The Quality & Compliance (QC) Manager is responsible for successfully managing all SLI patients and client services, whether billable or non-billable, as part of the Healthy Love Experience. The provision of service delivery for the Healthy Love Experience.

PRIMARY RESPONSIBILITIES:

Billing & Compliance:

· Enroll SisterLove Inc. (SLI) in insurance In-Network status

· Ensure all insurance contract agreements with SLI and the insurance company are current

· Ensure billable and non-billable services are appropriately split in AdvancedMD

· Update the billing system annually and order books for Charge Entry (e.g., ICD-10, CPT, and HCPCS coding).

· Maintain and manage Medicaid, Medicare, Manage Care, and all Insurance company credentials and inquiries

· Manage Clearinghouse 835 file and remittances from all insurance payers

· Ensure clinician credentials are accurate and current with SLI for billable services

· Handle all applications for SisterLove’s licensing and credentials to serve the community

· Have a clear understanding of and adhere to current GA laws and regulations

· Supervise and monitor all billing services activity for the organization

· Enforce HIPAA compliance

· Work with the Information Technology (IT) department to implement/improve the new billing system AdvancedMD EHR, CMR, Bill.com (fiscal portal), and EFT - Electronic fund transfers accurately

· Coordinate internal audit activities

Staff/Provider Development & Management:

· Manage and train all Intake/Billing staff regarding responsible of Medicaid Annuals, AdvancedMD, CMS, CMR, claim submissions, and denials weekly

· Interview and vet prospective medical providers for SLI health services

· Investigate all prospective healthcare partnerships for SLI medical services

· Monitor Intake and Billing staff their progress with entering patient demographics, medical services, and claims accurately in the billing system

· Ensure staff regulatory compliance training initially and annually

Financial Planning & Reporting:

· Supervise and oversee planning and budgeting for SLI Community Engagement Events and Associate Coordinator

· Manage/Report company cash flow for patient billable services

· Generate Non-billable program reporting for research data

· Prepare SLI patient financial statements monthly and annually, as needed

· Use data analysis to forecast SLI financial trends strategically

· Create itemized draw-down/ variance reports of company spending and work to reduce costs

· Generate reports for the Senior Management/Executive Team as needed

· Track important AR reporting and analyze billing trends

· Present monthly, quarterly, and annual financial statements to executives and the board of directors

· Create All Billing folders per FY term with the Insurance contract, Expenditure reports, Draw Down Variances itemized, and Outstanding Payments

QUALIFICATIONS:

Required:

• Bachelor's degree in Business Management, Finance, Accounting, or a related field

• Non-for-Profit or Clinic fiscal setting ten years or more preferred

• 7+ years of experience in a senior finance position

• Proficiency in Microsoft Suite and other business software

• Two (2) years supervising billers and intake coordinators

Preferred:

• Prescribe medication as needed

• Clinical training in family medicine

• Live within 20 miles of SisterLove’s offices

• Awareness of local resources available for HIV/STI prevention, treatment, and care

• CPR certification

Skills/Knowledge/Abilities:

• Extensive experience in the field of HIV/STI prevention, testing, and counseling

• Effective oral and written communication skills

• Computer literacy/proficiency in Microsoft Office Suite

• Good listening skills/non-judgmental attitude

• Motivational interviewing skills

• Excellent interpersonal skills, cultural humility, and the ability to work effectively with direct reports, colleagues, managers, and community partners

• Excellent training skills with the ability to adapt to multiple learning styles

• Excellent Budget Management Skills

• Ability to work with diverse populations

• Compassionate, empathetic

• Flexibility

SUPERVISION:

This position reports directly to the Administration & Operations Director

Additional Details

This is a full-time position based in Atlanta, Georgia. This position is 90% in-office. Excellent benefits package includes medical, dental, life, 401(k), and more.

Interested applicants should submit a resume with the subject line “Operations & Compliance Manager Position: “First and Last Name.” No phone calls or email inquiries, please. We look forward to hearing from you!

Disclaimer

The duties listed in this job description are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment.

SLI provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran by applicable federal, state and local laws.

Job Type: Full-time

Pay: $60,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• Weekend availability

COVID-19 considerations:
All vendors, clients, and customers are required to wear a mask on premise

Ability to commute/relocate:

• Atlanta, GA 30331: Reliably commute or planning to relocate before starting work (Required)

Education:

• Bachelor's (Preferred)

Experience:

• Microsoft Office: 5 years (Preferred)
• Medical billing: 3 years (Required)
• Medical records: 3 years (Required)
• HIPAA: 5 years (Required)
• insurance claims: 3 years (Required)
• EHR systems: 5 years (Required)

Language:

• Spanish (Preferred)

License/Certification:

• Medical Billing Certification (Preferred)

Willingness to travel:

• 50% (Preferred)

Work Location: One location

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