Regulatory Management Specialist

2 weeks ago

Wallingford, United States Masonicare Corp Full time
Job DescriptionJob Description

Regulatory Management Specialist

Masonicare Home Health & Hospice - Wallingford, CT


Day Shift / 40hrs/wk


Summary of Position: The Regulatory Management Specialist ensures regulatory activities are completed timely and accurately. Provides support to members of the Document and Provider Management Department in order to ensure that agency goals and objectives are met.

Essential Duties and Responsibilities:

  • Follows processes and procedures as outlined in the Document and Provider Management Operations Manual.
  • Responsible for processing the following in a timely and accurate manner. Corrects all issues timely in order to avoid write offs. Brings issues to manager’s attention.
  • Ensures timely and accurate Notice of Election information is entered in Medicare system
  • Ensures OASIS is delivered to states repository
  • Audits and reviews all invoices for the Hospice program.
    • Submits accepted invoices to Accounts Payable and ensures they are paid
    • Follows up with vendors on all invoices that will not be paid
  • Responsible for adherence to the Medicaid programs
  • Reviews eligibility of all patients on a monthly basis. Notifies branches of any issues. Follows up with providers to determine reason for ineligible status
  • Obtains authorizations for BHP and Medicaid Prior Authorization programs using electronic request system
  • Follow up on authorizations requested by clinician for Medicaid State Managed and Medicaid State funded patients. Ensures authorizations are listed on DSS portal in order for services to be billed.
  • Enters authorizations in EMR
  • Follow up on outstanding issues. Follows issues until resolution.
  • Responsible for upkeep and accuracy of the state’s Electronic Verification System (EVV)
    • Ensures all patients are accurately entered in system
    • Ensures visits, times and service codes are accurate
    • Works with branches to ensure clinicians utilize EVV system for tracking visits
    • Completes month end audits for reporting and billing
    • Reviews and corrects billing errors as needed
  • Responsible for greeting visitors, sorting mail and managing telephone traffic in a courteous and professional manner. Brings issues to manager’s attention in a timely manner.
  • Supports managers by generating reports, triaging incoming calls, faxing as needed, and other tasks as requested by the clinical manager.
  • Establish and maintain positive relationships with community contacts to facilitate the efficient return of orders for service and other time-sensitive documents.
  • Works on special projects and participates in designated committees as assigned.
  • Can be depended upon to report to work on-time, use time off appropriately, and complete annual education & medical requirements.
  • Communicates effectively and tactfully with clients, recognizing their age, cultural diversity, needs, abilities and physical condition.
  • Utilizes critical thinking skills and takes ownership of tasks.
  • Performs other duties as required.

Minimum Qualifications:

Education: High school Diploma or equivalent.

Experience: Knowledge of medical record policies and procedure. Familiarity with computer operations. Training in business or evidence of satisfactory work experience.

Certificates, Licenses, Registrations: Maintains current Drivers’ License and auto insurance.

Other: Possess reliable transportation


Day Shift / 40hrs/wk

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