Job Description

WHO WE ARE AT ELEMY:

Elemy, formerly Sprout Therapy, is building the first managed marketplace for in-home chronic medical care, starting with pediatric autism.  Over 1.5M children in the US are affected by autism, and nearly 30% of families are dissatisfied with the care they receive. Elemy is working tirelessly to change this by providing in-home care and leveraging cutting edge AI-powered technology to deliver a better experience to families, providers, and healthcare payers.

Today's US Child Care industry for autism, ADHD, and other developmental delays is a $38B market that is heavily fragmented and skewed towards in-clinic care. Elemy is looking to change the developmental delay care industry for the better by putting families and children at the center of what Elemy does. Elemy is bringing ABA care to family's homes, and providing more resources and tools for therapists to give the best care possible.

Since launching in April 2020, Elemy has become one of the fastest growing healthcare companies in the United States, scaling from 4 to over 1000 team members in under 18 months, and on track to grow revenue by over 600% this year. The company is backed by leading investors in healthcare and technology, including General Catalyst, Founders Fund, SignalFire, e.ventures, 8VC, Felicis Ventures, and Bling Capital. 

ABOUT THE ROLE

The Elemy Compliance Program is responsible for implementation of an effective compliance program consistent with the U.S. Federal Sentencing Guidelines and guidance of the HHS Office of the Inspector General. The Program is responsible for the promotion of a comprehensive approach to compliance with health care laws, regulations, and policies across Elemy service lines. The Program develops, implements, and enforces Elemy policy related to clinical operations and supports methods of preventing and detecting inappropriate, improper, and fraudulent conduct in the furnishing of health care services.

The Compliance Auditor/Educator provides both strategic and tactical support to the Elemy Compliance, Revenue Cycle and Clinical Quality function. This position serves an internal audit function as well as an internal resource for teammates and leaders at Elemy in ensuring an effective compliance program, including but not limited to developing and managing audit processes, policies and procedures; leading and coordinating external reviews and related inquiries (including standardizing and enhancing internal procedures relating to the same); and implementing and managing the internal billing, coding, and documentation compliance education and training program. This position reports to the Director of Compliance and will have a strong working relationship with all Elemy teammates, including leadership in Clinical Operations, Finance, Revenue Cycle Management and Compliance.

WHAT YOU'LL DO

Strategy:

• Evolve, enhance, and manage the auditing & monitoring element of the compliance program with respect to providers.
• Standardize and improve Elemy's audit response processes.
• Partner with Operations and Clinical Education leaders to implement and manage billing and coding peer review program for new providers as well as tenured providers.
• Collaborate with stakeholders to plan the rollout of billing/coding/documentation compliance education and communication.
• Partner with stakeholders to identify and manage audit risks and work with the Director of Compliance and Revenue Cycle leadership to provide creative solutions to bridge regulatory requirements with business objectives. Evaluate provider compliance with applicable federal/state laws and payer standards.
• Work with the Director of Compliance and Revenue Cycle to develop short- and long-term auditing/monitoring program strategies. 
• In coordination with the Director of Compliance and Revenue Cycle, the clinical team, and the operations team, develop standardized triggers for internal audits and establish a reporting structure and calendar for audit result dissemination. 
• Develop and maintain scalable compliance policies and procedures for individual providers.

Tactical:

• Conduct internal chart reviews and follow-up/remediation based on clinical, administrative, operational, and contractual triggers.
• Periodically review reports and analyses from billing vendor(s) and EMR(s), as necessary.
• Support and coordinate chart review processes (internal and external) in the context of transactional due diligence and integration.
• Support, coordinate, or conduct random chart reviews, as part of Elemy's commitment to excellence.
• Consolidate and standardize auditing processes for individual providers
• Support Elemy through the cycle of any Targeted Probe & Educate (TPE) activities, ensuring preparation, attendance, proper education, and follow up/remediation with Elemy providers.
• Track, analyze, and identify deficiencies and document corrective actions resulting from internal and external audits.
• Internal investigations of billing/coding/documentation compliance reports independently or in partnership with the Director of Compliance.
• Coordinate external audits with system partners, acting as a point of contact and liaison in collecting clinical documentation, policies, processes, and related items. 
• Participate in exit interviews for external audits and develop internal tracking systems to ensure compliance with action items provided by the auditing system partner. 
• Collaborate with clinical, operational, and administrative teams on auditing, tracking, reporting, and initiatives to achieve and maintain Behavioral Health Center for Excellence (BHCOE) accreditation.

Execution:

• Execute all compliance projects, ensuring effective communication to stakeholders for each initiative or project.
• Prepare reporting, including metrics and status updates, on behalf of the Elemy compliance function.
• Work with stakeholders and outside vendors to develop and implement billing/coding/documentation compliance education and training and ensure completion of education initiatives.
• Collaborate with the Director of Compliance Revenue Cycle Management leadership and subject matter experts to implement education and awareness programs needed to address areas of opportunity identified during reviews.
• Maintain records of compliance reviews/monitoring.
• Support management of outside vendors for periodic third-party reviews.
• Serve as a point of contact for Elemy teammates and leaders for audit and other compliance-related questions and concerns.
• Communicate with teammates regarding audit matters and ensure resolution.
• With guidance from the Director of Compliance, engage in ongoing assessment and modification to plans and practices as needed to achieve target outcomes. 
• Maintain and respond to inquiries and investigations as part of Elemy's Speak Up hotline.
• Other duties as assigned.

WHAT YOU'LL NEED

• At least 5 years of ABA Therapy industry experience
• BCBA certification preferred
• At least 5 years of billing and coding experience (ABA Therapy billing and coding is preferred).
• Understanding of healthcare laws, regulations, regulatory bodies and compliance standards and risks relevant to ABA Therapy.
• Ability to coordinate and work effectively across a geographically dispersed organization.
• Ability to work remotely and autonomously, as necessary.

At Elemy, we are a globally distributed team with many of our team members located throughout the world, including in the following cities: San Francisco, New York, Los Angeles, Miami, Toronto, Montreal, and Kyiv. While everyone currently works remotely, we envision a future that balances face to face collaboration with a remote friendly environment.

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position.

_Elemy is an equal opportunity employer that is committed to providing all employees with a work environment free of discrimination and harassment. We celebrate diversity and welcome applicants from every background and life experience. _

 #LI-Remote