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Compliance Coordinator

Company: Health Source MSO
Location: Alhambra
Posted on: May 12, 2022

Job Description:

SummaryThe Compliance Coordinator position will be responsible for running, reviewing and sending monthly timeliness report(s) to the Health Plans. Additionally, will be responsible for insuring each department is compliant with Compliance and Company administrative policies and guidelines.Duties and ResponsibilitiesProvide support to management to ensure that all claims and regulatory responsibilities are met - including statutory returns, claims timeliness reports, universal listing and regulatory auditsGathers documentation to support negotiated resolution of non-compliance issues.Liaison with managers and executives of varied business units during regular audit cycles to determine whether departments are operated efficiently and effectively, as well as, to recommend improvements for internal controls and increasing revenues and decreasing costsReview and evaluate departments to determine whether they are compliant with established policies and proceduresAssist in creating and proofreading all Claims/Compliance policies and procedures. And renders decisions on unusual problems involving policy interpretation.Evaluate adequacy of corrective action(s) taken by departmentsSupervise and train each audits' staff auditors and delegate tasks to each teamMaintains contact with applicable agencies/organizations for guidance in the solution of compliance issues.Monitors and evaluates all departments' performances to ensure compliance is being met; recommends action(s) to correct deficiencies.Plans and manages projects and/or programs by writing or discussing plans, recommendations, and/or findings.Heavy phone contact with policyholders, providers, Health Plans, and interested third parties.Audits regulatory guidelines for interest, applied interest payment for emergency room claims, denial accuracy and timeliness of claims.Organizes audit including pulling all data required and does a preliminary audit prior to forwarding to the Compliance Manager. Flagging all preliminary errors and questionable claimsAssist with written response audit CAP letters to correct deficiency identified by the Health Plan.Assist claims with pre-logging of claims as necessary.Participates in staff meetings and audits.Other duties as assigned by the Compliance Manager.QualificationsAA degree1 - 3 years work experience in Compliance or compliance auditing in a managed care environmentExperience must include medical terminology, ICD-10 coding, CPT coding, and knowledge of federal billing and reimbursement guidelines.Working knowledge of healthcare compliance policies, practices, and systemsProject management skills.Ability to draft and revise documents including policies, standards, analyses, and reports.Computer literacy required including MS OfficeTyping skills of at least 40 wpm.

BenefitsMedical InsuranceDental InsuranceVision InsuranceLife InsurancePaid Time Off401K

Keywords: Health Source MSO, Alhambra , Compliance Coordinator, Other , Alhambra, California

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