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General Compliance Specialist

Beaver Medical Group
Redlands, CA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

JOB FAMILY SUMMARY:

 The General Compliance Specialist will be a part of the General Compliance Team.  General Compliance assignments will include assisting in the performing and tracking of regulatory required compliance activities including training, OIG/GSA exclusion screening, and HIPAA auditing. The General Compliance Specialist responds to the health plan audits for both CMS and HHS risk adjustment. In addition, this position assists in the activities of the EPIC Forms Committee.

SUPERVISORY RESPONSIBILITIES:

None, although may be assigned responsibility for the training, orientation, assistance and work flow coordination of lower level Coding Specialists or Compliance Personnel.

ESSENTIAL JOB DUTIES & RESPONSIBILITIES:

The following are exemplary essential job duties and responsibilities and are not intended to represent an all-inclusive listing of related essential functions of the position

  1. Assists in new hire and annual compliance training for EPIC Management staff and affiliates.
  2. Performs monthly HIPAA privacy audits.
  3. Ensures that employee lists are updated and monthly GSA/OIG exclusion checks are performed.
  4. Assists in responding to health plan risk adjustment validation audits for Medicare Advantage and HIX plans.
  5. Performs general coding audits to assist clients in billing compliance.
  6. Tracks and submits diagnosis coded deletions to the health plans for risk adjustment.
  7. Supports various committee functions by preparing meeting materials.
  8.  

MINIMUM & PREFERRED QUALIFICATIONS:

 

Education/Training

Minimum:  High School diploma or equivalent. 

Preferred:  Associate’s or Bachelor’s degree in Finance, Economics or Health Management related fields from an accredited college or university.

 

Experience

Minimum:  Two years previous experience in CPT-4, ICD9/10, & HCPCS Coding.

Preferred:  Practice Management, Managed Care or Web application experience.  Five to seven years’ experience in CPT, ICD-9/10, & HCPCS Coding; experience in abstracting and chart auditing; and, experience in report design and interpretation.

Preferred:  Demonstrated and/or verifiable experience managing or leading professionals through influence and collaboration, and experience in Provider and Medical staff education.

 

Certification(s)

Current CPC or COC Certification required. CHC preferred.

 

Driver’s License

Valid California driver’s license required and insurability under the company’s insurance carrier standards as applicable to job requirements.

 

Skills, Knowledge & Abilities

  • Ability to successfully uphold the established customer service standards and Company Mission Statement.
  • Strong analytical skills as related to data, information, and data entry.
  • Excellent communication skills both oral and written.
  • Capability to research and resubmit HMO and Clearing house rejections identify problem areas and make recommendations for change.  Ability to work independently in a high production work environment and the ability to effectively communicate with all levels within the organization.  
  • Excellent presentation, written and verbal communication and interpersonal skills, as well as strong analytical skills required.
  • Knowledge of computer applications (Email, Excel, Word) at the intermediate to advanced level of use.  Possession of proper and thorough knowledge to proactively ensure proper systems and controls are in place to optimize operations of the team and ensure consistency, completeness and accuracy in Coding applications.
  • Ability to effectively interface with IS, HMOs, Finance and clinical professionals, and strong progression in work history with proven leadership abilities

May be assigned special project or other assignments and work tasks that are generally within the scope and level of the position, and relative to the need for flexible Company operations.

 

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  While performing the duties of this job, the employee is regularly required to sit, stand, use hands to touch, grasp, handle or feel objects, tools, or controls; and talk and hear.  Specific vision abilities required by this job include close vision, distance vision and the ability to focus. The work environment characteristics described here are representative of those an employee encounters while performing the essential function of this job.  The noise level in the work environment is usually moderate.

Company Description
Beaver Medical Group is one of the largest medical groups in Southern California with many services located on-site. Over 200 physicians, along with other medical professionals including Optometrists, Physical Therapists, Nurse Practitioners, Physician Assistants and Health Educators practice in 25 specialties.

OUR MISSION is to deliver exceptional quality healthcare management, professional and support services with a firm commitment to excellence, integrity and innovation, making a lasting difference in the lives of patients and our communities.
We collaborate with medical groups and health care providers, offering expertise and insight to meet their unique challenges.
Our patient services are built on a foundation of compassion, trust and respect.
We strive to build an outstanding team, offering opportunities for growth, recognition and reward in an environment of open communication, trust and mutual respect.
Our services will grow and improve as we create value for our investors and provide mutual benefit for our partners.

Beaver Medical Group

Beaver Medical Group is one of the largest medical groups in Southern California with many services located on-site. Over 200 physicians, along with other medical professionals including Optometrists, Physical Therapists, Nurse Practitioners, Physician Assistants and Health Educators practice in 25 specialties. OUR MISSION is to deliver exceptional quality healthcare management, professional and support services with a firm commitment to excellence, integrity and innovation, making a lasting difference in the lives of patients and our communities. We collaborate with medical groups and health care providers, offering expertise and insight to meet their unique challenges. Our patient services are built on a foundation of compassion, trust and respect. We strive to build an outstanding team, offering opportunities for growth, recognition and reward in an environment of open communication, trust and mutual respect. Our services will grow and improve as we create value for our investors and provide mutual benefit for our partners.

Address

Redlands, CA
USA

Industry

Business

Website

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