Compliance Specialist - Fulltime - In Office

Job Description

Job Description

Role and Responsibilities: Responsible for all activities related to order compliance and management of provider credentials and demographics in system(s); this position assures optimal regulatory compliance and contributes to positive cash flow.

Essential Functions

• Monitor orders which are in the Mosia escalations folder and perform necessary follow-up.
• Provide education and support to Medical Records staff as it pertains to Mosia and indexing, to ensure timely and appropriate follow-up.
• Monitor reports and Mosia tracking features to assure goals of Orders Lifecycle are met.
• Perform follow up related to timely receipt of unsigned Orders including: Calls to physician offices and communication with Clinical team members/ managers to resolve issues as needed.
• Elevate unresolved issues to Team Leader or Manager
• Document actions in system to support compliance with internal policies and regulatory guidelines
• Verify credentials including: licensing, NPI, PECOS, OPRA, and OMIG/OIG/GSA sanctions, for new Providers. and update system accordingly.
• Monitor and maintain Add/Change Physician workflow, including: provider additions and changes, updating provider demographics, delivery methods, as well as changes in corresponding orders as needed.
• Develop working relationships with Physician offices
• Mail, track, and file signature attestation letters for new MDs.
• Communicate regularly with manager to ensure maximum compliance with orders
• Other duties as assigned.

This job description reflects management’s assignment of essential functions; and nothing in this herein restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Education / Experience Requirements

Associates degree required; in lieu of degree, at least 2 years’ experience in Medical Records, or experience in a healthcare setting with a full understanding of a Medical Records Specialist role.

Qualifications

• Medical knowledge/ terminology a plus.
• Demonstrated ability to apply critical thinking to tasks.
• Outstanding customer service and communication skills.

Work Environment

The Compliance Specialist is primarily in an office setting and may be exposed to outdoor conditions.

The working conditions are classified as sedentary work:

• Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Physical Requirements

The following is a description of the physical requirements on a daily basis for the Compliance Specialist. While performing the duties of the job the employee is regularly expected to:

• Stand
• Sit
• Hear
• Walk
• Talk
• Stoop or kneel
• Repetitive motion