Compliance Coordinator

Qualifications

• Education: Bachelor’s degree is required. Master’s or Juris Doctorate degree is preferred.
• Experience: A minimum of 2-4 years’ experience in a healthcare organization, to include demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must.

Functions and Responsibilities

• Implementing the organization’s processes and policies designed to ensure compliance with Federal healthcare program requirements
• Serve as a resource to leadership, employees and staff related to compliance requirements
• Advise on issues concerning compliance and ethics matters including recommending controls designed to ensure compliance
• Work collaboratively with leadership in compliance and ethics program development and implementation
• Establish effective working relationships and build credibility within the organization to support a culture of ethics and compliance
• Interface directly with facility employees and serve as a sounding board for their concerns about ethics and compliance matters
• Manage the physician compliance with activity logs and visit note submission
• Work collaboratively with the Director of Compliance and other departments, if applicable, to investigate or supervise the investigation of compliance and ethics concerns about the organization that are raised through reporting mechanisms
• Oversee the implementation of the company’s education and training program that focuses on the requirements of the company’s compliance program to ensure that all directors, employees, contractors and physicians within the organization are knowledgeable of Federal healthcare program requirements and the requirements of the company’s Compliance program as required to perform their respective roles
• Ensure distribution of compliance and ethics policies and procedures and the company’s Code of Conduct
• Identify risk areas and assist in developing auditing, monitoring and oversight processes related to identified risks
• Oversee the implementation of corrective actions and monitoring in response to identified issues and audits and providing updates
• Develop monitoring systems and processes for compliance and ethics issues
• Prepare monthly compliance reports identifying compliance issues
• Report to the Compliance Pre-Billing Manager on compliance matters on a routine basis

Additional Responsibilities

• Compliance pre-billing audit reporting and follow up with offices
• OIG/SAMS/Medi-Cal Exclusion Check
• External Credentialing
• Monitor CMS, FI, MAC, state and local guidelines to determine changes to documentation and billing requirements
• Monitor and review annually the Conditions of Coverage and Conditions of Participation to determine changes to documentation and billing requirements in order to meet all requirements to continue to bill claims through the Medicare and Medicaid programs