PNO Compliance Coordinator
1 month ago
Summary
Under the general direction of the Provider Network Operations (PNO) Delegation Specialist, the Compliance Coordinator supports the day-to-day audit and monitoring processes to ensure the department delivers high-quality reviews and results. They will assist with coordinating large department projects or lead special projects, ensuring projects are completed timely and successfully. The Compliance Coordinator must have the ability to deliver quality results with tight deadlines and maintain accurate records and documentation.
Duties and Responsibilities
• Requests, collects an distributes a variety of documentation from departmental teams necessary to facilitate the auditing and monitoring functions
• Ensures auditing and monitoring documentation is complete, and received in a timely manner
• Maintain MedPOINT and Health Plan training materials
• Collect and store all provider training materials for plan, State and Federal audit needs
• Generate and distribute departmental provider warning and non-compliant letters
• Review and validate all letter templates to comply with Health Plan, State and Federal regulatory standards
• Oversees member notice process for accuracy and compliance
• Manage corrective action plans and reporting needs
• Interacts with departmental and MedPOINT stakeholders for deliverable reviews and approvals
• Conducts process reviews to ensure validity and accuracy of analytical results
• Prepare and submit all standard and nonstandard compliance documents and researching related issues of highly complex nature and recommending solutions
• Aggregate and analyze audit findings into a reportable format; to include, monthly, quarterly, or annual delegation activities
• Assist in the revision of delegation oversight audit tools in accordance with standards set by ICE, NCQA, the Plan’s policies and procedures, and other State and Federal guidance tools as required
• Maintains and updates status logs for assigned projects, contributes to, or produces delegation oversight activity reports to management
• Ensure HIPAA compliance is always observed/performed
• Understand and follow the MPM Employee Handbook policies and procedures
• Perform additional duties/assignments as needed
Minimum Job Requirements
• Bachelor’s Degree
• 2+ years Managed Care or Healthcare experience in Provider Network Management, a plus
• Knowledge of Health Plan Provider Network oversight and audit processes, a plus
• Ability to identify, analyze, and interpret trends or patterns
• EZ-CAP knowledge and experience, a plus
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
Skill and Abilities
• Effective verbal and written communication skills, a must • Exceptional attention to details
• Excellent planning, analytical, and organizational skills
• Ability to prioritize and manage multiple tasks and projects simultaneously • Strong interpersonal skills; ability to collaborate effectively with both internal and external contacts • Demonstrated critical thinking and problem-solving skills
• Ability to work independently and take direction
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