Coordinator, Compliance (Remote)
- Assists in the monitoring of business and operations activities for compliance with internal audit process and external health plan and regulatory rules and regulations.
- Upload monthly, quarterly, and annual reports to secure sites while maintaining high accuracy, timeliness, and security of the data.
- Perform detailed examinations of audit documentation.
- Ability to communicate, interact, and work well with others.
- Coordinate deliverables for internal/external audits, CAP’s, Compliance, and PI/QM projects.
- Coordinate annual policy reviews, makes policy revisions as directed, keep policies organized, revised, and updated in compliance with regulatory and specific contract requirements.
- Does research, updates and assists in tracking of licenses specific to State guidelines and includes clinician licenses.
- Regulations are added, removed, and changed, as such Compliance Specialist must assist and stay up to date with any regulatory action relevant to healthcare.
- Compiles data and can put in pivot table within Excel, etc.
- Works well under deadlines and can meet required timeframes.
- Healthcare industry experience and knowledge of medical terminology
- Knowledge of health plan regulatory reports such as ODAG, NCQA /URAC, ICD 10 coding, medical terminology, and EMR Systems is helpful.
- Previous internal audit experience preferred.
- Proficiency in Microsoft Office Applications including Excel, PowerPoint, Adobe, and Word.
- Must be ethical and trustworthy.
- Excellent writing skills.
- Knowledge of HIPAA regulations and guidelines.
- Must be organized, detail oriented, and can multitask.
- Project management skills preferred.
- Excellent verbal and written communication skills.
- Critical thinking and problem-solving skills.
- Must be able to work in a team environment and independently.
- High school diploma or GED equivalent.
- Two (2) years administrative experience in health plan, medical facility, or related field.
- Two (2) years of experience in Customer Service, Billing/Claims, Project Management, or related environment preferred.
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