MSO Compliance

The Managed Care Compliance and Audit Coordinator will assist with compliance and auditing functions of PHP/ MSO (Management Services Organization), including, but not limited to, internal and external audit activities to the Claims, UM, Credentialing, CM functions, and quality improvement initiatives. This role will also be responsible for monitoring regulatory requirements and understanding how requirements impact MSO operations. Responsibilities include efficiently managing the workflow of policies and procedures, ensuring strict adherence to deadlines and established processes, uploading documents, and conducting follow-up reporting. Moreover, the position entails generating and reviewing policies for MSO, coupled with the management of storage and handling of all policy documentation.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook , Twitter , or Instagram .

• Strong communication skills, verbal, non-verbal, written, and oral
• Proficiency in collaborating with Health Care Providers
• Demonstrates strong and effective problem-solving abilities
• Exceptional organizational skills with a proven ability to complete projects in a timely manner
• Proficient in computer skills, with an in-depth knowledge of Microsoft Excel
• Foster professional relationships with all departments, working collaboratively to achieve organizational objectives

Required:

• Previous managed care compliance experience  
• H.S. Diploma or Equivalent

Preferred:

• Familiar with Medicare and MediCal programs preferred
• Familiarity with ICD-9, ICD-10, CPT-4, and HCPCS coding
• One to two years of experience in Compliance and Contracts Management