Compliance Coordinator (Um)

Summary

MedPOINT Management is committed to conducting its business and operations following the highest legal and ethical standards. Our Code of Conduct sets forth our expectations of management, employees, and contractors to act under applicable laws and Company policy. MedPOINT’s Compliance Department ensures our culture maintains ethical standards, strives to significantly reduce the risk of fraud, abuse, and waste in the healthcare industry, and enhances the quality of services and care to patients. The Federal Sentencing Guidelines for Compliance Programs guide MedPOINT’s Compliance Program.

Duties and Responsibilities

1. Prepare and assist with submissions of universe reports and other audit documentation to external auditors from health plans

2. Prepare routine reporting on claims statistics for accuracy and turnaround time

3. Supports Utilization Management operations with Health Plan Oversight Audits/Ad Hoc Requests

4. External liaison to Health Plan Oversight Auditors

5. Initiate and follow up on requests for Health Plan Oversight Audits

6. Interface with various departments for compliance-related activities as needed

7. Communicate reminders to business owners for upcoming external audits for universe selections, pre-audit materials, and approaching corrective action deadlines

8. Supports internal quality reviews of department processes

9. Supports Utilization Management operations for internal quality review of the UM process

10. Participate in Regular and Ad Hoc Compliance Committee meetings

11. Miscellaneous projects as assigned to support Regulatory Affairs and Compliance department

12. Adhere to MedPOINT Management’s core values: Accountability, Community, Celebration, Integrity, Innovation & Collaboration

Minimum Job Requirements

· High School diploma or equivalent

· Two (2) or more years of Utilization Management experience in a healthcare delivery setting

· Experience in an HMO or in a Managed Care setting preferred

· Medicare/Medi-Cal experience

· Knowledge of NCQA Standards, DMHC, DHCS, and CMS regulatory requirements

Skill and Abilities

· Proficiency in Microsoft Applications, Word, and Excel

· Knowledge of ICD-9/10, CPT coding, and EZ CAP

· Strong organization skills and knowledge of managed care environment

· Ability to work at a high level of speed while maintaining accuracy

· Ability to analyze and problem solve

· Ability to work well with Physicians, Internal Staff, and Health Plan representatives