Clinic Compliance Manager

Overview Tufts University School of Dental Medicine (TUSDM) offers one of the most forward?looking educational environments in dental medicine and maintains a Compliance Program focused on meeting federal, state, and accreditation requirements, including Anti?Kickback, Fraud and Abuse, and HIPAA Privacy and Security regulations. The TUSDM Compliance Program is an evolving function that continues to strengthen audit oversight, adapt to a dynamic regulatory environment, and establish consistent, best?practice compliance processes across clinical and academic operations. The Clinic Compliance Manager plays a key role in this effort by bringing experience, insight, and a risk?based perspective to help advance and sustain effective audit and compliance practices. This position reports to the Senior Compliance Officer and works closely with the Revenue Cycle Department, Clinic Administration (Clinical Affairs), Post?Graduate Practice Managers, and billing, clinic, and academic management teams. This is a hybrid, part?time (24 hours per week; approximately 0.68 FTE), benefits?eligible position, with on?site presence required as needed to support clinical and operational needs. The posted compensation range reflects a full?time (35?hour) workweek and will be prorated accordingly. What You’ll Do As a core member of a small and evolving Compliance Team, the Clinic Compliance Manager partners closely with the Senior Compliance Officer to help build, implement, and advance audit and compliance practices across Tufts University School of Dental Medicine (TUSDM). The role develops, executes, and oversees Compliance Audit Work Plans for the Pre?Doctoral and Post?Graduate Clinics, with an emphasis on independent audit review, risk assessment, and best?practice application rather than day?to?day billing operations. The Clinic Compliance Manager conducts routine compliance audits of the dental clinics to assess medical necessity and appropriate levels of care billed, in accordance with Medicare, Medicaid, other federal insurance programs, and third?party payer requirements. This position brings experience and judgment to an evolving environment, helping to establish consistent audit approaches and translate regulatory requirements into practical, sustainable compliance processes. The role provides guidance, education, and training and recommends corrective action plans, as appropriate, to members of the TUSDM workforce, including students, residents, fellows, faculty, staff, volunteers, and TUSDM?sponsored visitors. The Clinic Compliance Manager collaborates closely with Clinical Affairs, Practice Managers, the TUSDM Billing Department, and external entities to identify risk, interpret regulatory guidance, and support continuous improvement across clinical, academic, and revenue?cycle operations. Key responsibilities include: Conduct accurate and compliant reviews of medical and dental records and provider services to identify audit findings, compliance risks, and opportunities for coding education; develop and recommend corrective action plans to address instances of non?compliance. Partner with the Senior Compliance Officer to help establish, refine, and maintain audit processes, work plans, and best practices appropriate for a growing compliance program. Formulate and update, at least annually, billing guidelines and policies related to professional fee billing for both medical and dental services, informed by audit results and regulatory requirements. Monitor pre? and post?billing compliance and assist in mitigating identified risk areas through audits and other risk?assessment techniques; analyze findings and make recommendations to strengthen controls and processes. Prepare clear, well?documented audit reports outlining findings, trends, and recommendations; compile and maintain audit results within the audit database. Develop and deliver training materials and educational programs related to coding, documentation, and billing compliance for providers and clinical and administrative staff, including independent contractors. Participate in TUSDM meetings and provide ongoing education and guidance on coding? and audit?related topics to students, faculty, staff, and workforce members. Coordinate and manage requests, inquiries, or investigations from regulatory agencies and third?party payers, working closely with internal stakeholders as needed. Perform additional duties and special projects as assigned to support the continued development and effectiveness of the Compliance Program. What We’re Looking For Basic Requirements: Knowledge and experience typically acquired by: Bachelor?s degree Seven (7) or more years of experience performing independent billing and coding audits within medical and/or dental practices, academic health centers, or hospital systems Demonstrated knowledge of Medicare, Medicaid (including MassHealth), and commercial medical and/or dental reimbursement structures, third?party billing practices, and clinical patient care systems, with the ability to learn and apply dental?specific workflows and systems as needed Proven experience assessing regulatory compliance, identifying risk, and developing well?documented audit findings and corrective action recommendations Familiarity with ICD?9/ICD?10 diagnosis codes and CPT coding, and ADA (dental) procedure codes or the ability to learn and apply dental?specific coding standards in an audit context Proficiency with Microsoft Word, Excel, PowerPoint, Outlook, email, and internet?based tools Certified Dental Coder (CDC) or a comparable professional coding certification, with demonstrated audit experience and the ability to apply or obtain dental?specific credentials as needed Preferred Qualifications: Experience working in academic healthcare or other complex clinical environments Familiarity with dental or clinical management systems such as Axium, Dentrix, or Epic Experience supporting, implementing, or strengthening audit programs or compliance processes in a developing or evolving organization Prior experience developing or delivering training related to coding, documentation, or billing compliance The posted compensation range reflects a full?time (35?hour) workweek and will be prorated accordingly. Pay Range Minimum $106,100.00, Midpoint $132,600.00, Maximum $159,100.00 Salary is based on related experience, expertise, and internal equity; generally, new hires can expect pay between the minimum and midpoint of the range. #J-18808-Ljbffr ARMA International