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.
ESSENTIAL DUTIES AND RESPONSIBILITIES
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.
EDUCATION / EXPERIENCE
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
Website : http://www.tenethealth.com
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: