Compliance Clerk

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