Job added in hotlist
Applied job
Contract job
Recruiter job
Employer job
Expanded search
Apply online not available
View more jobs in Encino, CA
View more jobs in California

Job Details

Compliance Coordinator- Encino CA

Company name
TH Medical

Encino, CA

Apply for this job

3 hit(s)  


Compliance Coordinator- Encino, CA','!*!Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers—hospitals, health systems, physicians, self-insured employers, and payers—to better connect every point of care and wellness management.  Are you ready to be part of our solutions?  Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!


The Compliance Coordinator prepares for audits of delegated functions by health plan auditors.  This position is responsible for submitting all health plan reporting and routine reports to regulators timely. The Compliance Coordinator provides support as needed to the claims department in the area of drafting corrective action plans (CAP) for audit reports about denial letters, in addition, performs limited internal audits under general direction of the Chief Compliance Officer.



1. Schedules claims audits with the health plans and sends claims reports with sufficient lead time for selection of audit sample and documentation retrieval.2. Based on the audit sample, obtains claim forms, attachments and all other documents, such as EOBs, bank statements, and denial letters.3. Assembles all documents in logical sequence for external auditors to heighten perception of preparedness and enhance likelihood of positive audit outcome.4. Coordinates the preparation of annual questionnaires and submits completed reports to health plans annually and as needed for pre-contractual audits.5. Assists the claims management in drafting CAP responses by supplying working papers and other analysis.6. Schedules UM and QM audits with the health plans and sends requested denial letter reports to the health plans with sufficient lead time for selection of audit sample and documentation retrieval.7. Based on the audit sample, obtains denial letters, deferral letters, print screens, attachments and all other documents in support of denial letters.8. Assembles all documents in logical sequence for external auditors to heighten perception of preparedness and enhance likelihood of positive audit outcome.9. Assists the operations management in drafting CAP responses by supplying working papers and other analysis.10. Ensures that the most current policy and procedure binder relevant to the audit area is available for audits11. Coordinates the submission of MTR and PDR reports for both monthly and quarterly submissions.  12. Prepares and submits any supporting documentation that may be requested by the health plans13. Reviews submissions to identify any possible inaccuracies before documents are submitted.  14. Submits monthly, quarterly, semi-annual and annual reporting to the health plans.15. Submits UM denial letter packages to the health plans within the health plans’ timely submission requirements.16. Maintains compliance related correspondence from health plans in an organized and easy accessible method.17. Performs other work as directed by the compliance officer, claims operations, UM operations or compliance analyst as needed.18. Maintains and keeps in total confidence, all files, documents and records that pertain to the operation of business of Cap Management Systems.19. All other job related duties as it relates to the job function or as delegated by the management team.','!*!KNOWLEDGE, SKILLS, ABILITIES

Excellent written and oral communication skills. Highly proficient use or Microsoft Word, Excel, and Access.Familiarity with EZCap preferred.Proficiency with, Crystal or other report writing program preferred.At least 3 years of managed healthcare experience preferred.


High school diploma or equivalent required

','Conifer Health Solutions','CA-Encino','','Conifer Value Based Care','Full-time','Full-time','Days','Days','','','','','','','1705039341','Compliance Coordinator- Encino, CA

Company info

TH Medical
Website :

Company Profile
At Tenet Healthcare, we’ve had a longstanding commitment to serving our patients, our employees, our physicians and our partners. Today, we’re one of the nation’s leading healthcare services companies, with a comprehensive network that extends from coast to coast:

Similar Jobs:
Medical Management Director in Encino CA','!*!As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We ...
Credentialed Trainer, Electronic Health Record UCLA Health and David Geffen School of Medicine at UCLA We’re seeking Credentialed Trainers to train our employees on the upgraded version of CareConnect, UCLA Health’s electr...
\n\nJob Description\nPosition Description:Welcome to one of the toughest and mostfulfilling ways to help people, including yourself. We offer the latest tools,most intensive training program in the industry and nearly limitlessopp...
What I liked about the service is that it had such a comprehensive collection of jobs! I was using a number of sites previously and this took up so much time, but in joining EmploymentCrossing, I was able to stop going from site to site and was able to find everything I needed on EmploymentCrossing.
John Elstner - Baltimore, MD
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
ComplianceCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
ComplianceCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2018 ComplianceCrossing - All rights reserved. 169