Compliance Program Coordinator

1 week ago


Los Angeles, California, United States MedPOINT Management Full time
Job Overview

MedPOINT Management is committed to upholding the highest standards of ethics and compliance in its business operations. Our Code of Conduct serves as a guiding principle for our management, employees, and contractors to ensure adherence to applicable laws and company policies. The Compliance Department plays a crucial role in maintaining a culture of integrity, minimizing the risk of fraud, abuse, and waste in the healthcare industry, and enhancing the quality of services and care to patients. The Federal Sentencing Guidelines for Compliance Programs inform our Compliance Program.

Key Responsibilities

  1. Prepare and submit audit universe reports to external auditors from health plans.
  2. Review and validate audit documents to external auditors from health plans.
  3. Assist with internal quality reviews of department processes.
  4. Support Health Plan Oversight Audits/Ad Hoc Requests.
  5. Support internal quality review of the PNO process.
  6. Participate in Regular and Ad Hoc Compliance meetings.
  7. Backup personnel for communicating reminders to business owners for upcoming external audits for universe selections, pre-audit materials, and approaching corrective action deadlines.
  8. Interface with various departments for compliance-related activities as needed.
  9. Miscellaneous projects as assigned to support Regulatory Affairs & Compliance department.
  10. Adhere to MedPOINT Management's core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration.

Requirements

  • High School diploma or equivalent.
  • Experience in an HMO or in a Managed Care setting preferred.

Preferred Skills and Abilities

  • Advanced knowledge of Microsoft Applications, specifically Excel.
  • Knowledge of EZ-CAP is a plus.
  • Knowledge of Customer Service, Claims, or Referral processing in a health care setting.
  • Managed Care, and State and Federal regulations a plus.
  • Professional demeanor, excellent communication, and interpersonal skills.
  • Strong organization skills and knowledge of managed care environment.


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