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Remote Healthcare Delegation Compliance Coordinator

1 month ago

Redlands, United States Actalent Full time

Job Title: Delegation Coordinator

Job Description

The Delegation Coordinator will ensure timely processing of authorization requests, verifying eligibility, and obtaining additional non-clinical information by contacting the provider's offices. The Delegation Coordinator will ensure that all referral policies and procedures are followed as required to meet all contractual, regulatory, quality, and federal requirements. The responsibilities include:

- Verifying member eligibility and health plan benefits through the use of the health plan guidelines.

- Verifying specific procedures and diagnoses requested and coding them appropriately based upon CPT, ICD-10, and HCPCS codes.

- Ensuring all information in system application and the DOD workflow is correct and making changes/updates as necessary.

- Answering all authorization inquiries in a professional and positive manner, ensuring that all information given is accurate.

- Communicating with providers regarding authorizations, modifications, denials, and other matters pertinent to processing authorization requests or other DOD related correspondence.

- Composing basic letters, faxes, and emails which are sent to various providers as it relates to authorizations.

- Working collaboratively with internal departments to obtain information or documentation required to accurately process authorizations.

- Monitoring patient outcomes to identify areas for improvement and implementing changes as needed.

- Partnering with the DOD team to evaluate the delegation agreements between DHMSO and contracted entities, ensuring compliance.

- Utilizing authorization matrix, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making.

- Preparing denial letters for review by Medical Director or Nurse Reviewer(s) and distributing letters to appropriate recipients.

- Coordinating and assisting with patient appointments as needed and notifying patients of authorization status.

- Meeting production and quality requirements for Service Levels Agreements (SLA) with clients.

- Demonstrating strong analytical skills to review and assess compliance documentation, audit findings, and performance metrics.

- Assisting in ensuring that quality improvement initiatives are effectively implemented and tracked.

Hard Skills

+ Delegation Coordination

+ Compliance Auditing

+ HIPPA regulations

+ CPT, ICD-10, and HCPCS coding

Soft Skills

+ Analytical skills

+ Professional communication

+ Collaboration

+ Attention to detail

Job Type

This is a contract position with a duration of 6 Month(s).

Work Site

This is a fully remote position.

Work EnvironmentRemote. Monday - Friday 8-5pmFor immediate consideration, email your updated resume to kacgonzales@actalentservices. com along with a couple of reasons why you're a strong fit for the role.About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

+ Hiring diverse talent

+ Maintaining an inclusive environment through persistent self-reflection

+ Building a culture of care, engagement, and recognition with clear outcomes

+ Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.