Compliance Clerk Job at Health Source MSO in Los Angeles County

Summary The Compliance Coordinator will be responsible for ensuring each department is compliant with CMS and DMHC regulations and Company administrative policies and guidelines. Duties and Responsibilities Provide support to management to ensure that all claims and regulatory responsibilities are met - including claims timeliness reports, universal listings and regulatory audits. Research and gather documentation to assist in providing resolution of non-compliance issues. Liaison with managers of each business unit to determine whether departments are operating efficiently, as well as to recommend improvements for internal controls. Assist in development and review of policies and procedures to ensure they are up to date and compliant with CMS and DMHC regulations. Maintains contact with applicable health plan agencies/organizations for guidance in the solution of compliance issues. Manages internal projects and/or programs by discussing plans, recommendations, and/or findings. Audits regulatory guidelines for denial accuracy and timeliness of claims. Assist with organizing audits including pulling all required data and performing a preliminary audit review with Compliance Manager. Research and respond to Corrective Action Plans when deficiencies are identified by the Health Plans. Participates in department staff meetings. Other duties as assigned by the Compliance Manager. Qualifications AA degree 1 – 3 years work experience in Compliance or compliance auditing in a health plan or managed care environment. Experience in medical terminology, ICD-10 coding, CPT coding, and knowledge of federal billing and reimbursement guidelines. Working knowledge of healthcare compliance regulations with CMS and DMHC. Project management skills. Ability to draft and revise documents including policies, standards, analyses, and reports. Computer literacy required, including proficient use of Microsoft Word, Excel, and Outlook. EZ-CAP is a plus. Typing skills of at least 40 wpm. Benefits: Medical Insurance Dental Insurance Vision Insurance Life Insurance Paid Time Off 401K Matching

In Summary: The Compliance Coordinator will be responsible for ensuring each department is compliant with CMS and DMHC regulations and Company administrative policies and guidelines . Duties and Responsibilities include support to management to ensure that all claims and regulatory responsibilities are met . Maintains contact with applicable health plan agencies/organizations for guidance in the solution of compliance issues .

En Español: Resumen El Coordinador de Cumplimiento será responsable de garantizar que cada departamento cumpla con los reglamentos CMS y DMHC, así como las políticas administrativas y directrices de la Compañía. Duties and Responsibilities Proporcionar apoyo a la administración para asegurar que se cumplan todas las reclamaciones y responsabilidades regulatorias - incluidos informes de puntualidad de reclamaciones, listas universales y auditorías reguladoras. Investigar y recopilar documentación para ayudar en la resolución de problemas de no conformidad. Enlace con los gerentes de cada unidad de negocio para determinar si los departamentos están operando eficientemente, además de recomendar mejoras para controles internos. Asistir en el desarrollo y revisión de políticas y procedimientos para asegurarse de que estén actualizados y cumpliendo con las normas CMS yDMHC. Mantenga contacto con las agencias/organizaciones sanitarias aplicables para obtener orientación en la solución de asuntos de cumplimiento. Geren proyectos y/o programas internos mediante discusiones, hallazgos/recomendaciones o denigraciones de datos. Qualificaciones AA grado 1 3 años de experiencia laboral en cumplimiento o auditoría de cumplimientos en un plan de salud o entorno de atención gestionada. Experiencia en terminología médica, codificación ICD-10, codificación CPT y conocimiento de las pautas federales de facturación y reembolso. Conocimiento práctico de regulaciones de cumplimento sanitario con CMS y DMHC. Habilidades de gestión de proyectos. Capacidad para redactar y revisar documentos que incluyen políticas, estándares, análisis e informes.