Compliance Specialist
3 weeks ago
POSITION SUMMARY
The Compliance Specialist works closely with the QI/Compliance Manager and is responsible for a variety of tasks to promote regulatory compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:
•Reviews monitoring reports to determine possible areas of non-compliance; follows up with staff as necessary to correct errors.
•Provides back-up for documentation billing corrections ticket system.
•Provides technical assistance training on EMR system as needed as related to billing issues.
•Reviews weekly security audits to ensure compliance with agencies policies and procedures. Reports information to the QI/Compliance Manager.
•Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all providers who provide consumer care for the agency.
•Responsible for ensuring providers are credentialed with health plans.
•Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications.
•Coordinate with insurance companies to ensure practitioners are appropriately credentialed.
•Monitoring training requirements for credentialed staff/providers.
•Serves as a member of the Compliance Committee. Takes minutes at quarterly meetings and helps follow-up on outstanding items.
•Maintain knowledge of agency technology programs and/or systems needed to do the job and use them effectively.
•Other duties and/or responsibilities may be assigned by supervisor.
MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)
Education/Certifications:
High School diploma or equivalent required.
Experience:
1 to 3 years previous experience required
3 to 5 years previous experience preferred
Required Knowledge:
•Knowledge of electronic medical record systems
•Computer literacy with proficiency in Microsoft Office
•Prior credentialing experience strongly preferred
•Knowledge of federal, state, and insurance company regulations and contract requirements affecting compliance in a healthcare setting
Skills/Abilities:
•Ability to communicate effectively, both orally and in writing, to both internal and external customers.
•Ability to organize, develop, implement, monitor, and evaluate work plan goals and performance objectives.
•Ability to interpret and evaluate information
•Demonstrated ability to exercise independent judgment and to meet deadlines
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