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